Pediatrics revenue cycle management
Pediatric revenue leaks in vaccines and well-child visits - VFC reporting, EPSDT rules, immunization admin codes and Medicaid billing. AI agents capture every code across high volume.
Pediatrics runs on high volume and thin margins, which is exactly where revenue slips: Vaccines for Children (VFC) reporting, well-child and EPSDT visits, immunization product and administration codes, and heavy Medicaid and CHIP billing. MedXFlow supports coding, verifies coverage, and runs claims, posting and denials end to end.
Coding & documentation
- Vaccine & admin code capture - Captures vaccine product and administration codes, including VFC reporting, so none are dropped.
- Well-child & EPSDT coding - Supports well-child and EPSDT visit coding with the correct age and screening components.
- Sick-plus-well visit coding - Codes same-day preventive-plus-problem visits with modifier 25 so both get paid.
Eligibility & benefits
- Medicaid & CHIP verification - Verifies Medicaid, CHIP and commercial coverage at scale before visits.
Claims & submission
- High-volume claim scrubbing - Scrubs claims against payer and bundling edits at pediatric volume.
Posting & denials
- Payment posting - Auto-posts ERAs with line-level reconciliation.
- Denial management - Works immunization and EPSDT denials by root cause.
What you get
- Every vaccine and admin code captured
- Well-child and EPSDT coded correctly
- Coverage verified across Medicaid and CHIP
- Clean claims at pediatric volume
Frequently asked questions
How are pediatric vaccines billed?
Each vaccine has a product code and a separate administration code, and Vaccines for Children (VFC) doses require specific reporting. Capturing both the product and administration codes for every immunization is where pediatric practices most often lose revenue.
What is EPSDT in pediatric billing?
EPSDT (Early and Periodic Screening, Diagnostic and Treatment) is the Medicaid benefit for children's preventive and screening care. Coding well-child and EPSDT visits with the correct components is essential for full payment.