Eligibility Verification & Prior Authorization
Check insurance, confirm coverage for age-specific services, vaccines, developmental screenings and pre-authorizations to prevent denials.
Pediatric-optimised billing across newborn care, vaccinations, developmental assessments, chronic conditions, and specialty referrals — with age-specific coding and multi-disciplinary support.
Check insurance, confirm coverage for age-specific services, vaccines, developmental screenings and pre-authorizations to prevent denials.
Accurate coding for well-child visits, immunizations, developmental assessments, preventive care, chronic care, and specialty therapies.
Prompt claims filing, payer tracking, and follow-up to ensure timely adjudication and payment.
Active monitoring of outstanding claims, denial root-cause analysis, correction, and resubmission to maximize collections.
Special handling of immunization codes, preventive medicine E/M codes, combo visits (sick + well), and payer-specific requirements.
Support for pediatric sub-specialties: cardiology, endocrinology, neurology, neonatology, chronic disease management.
Quality checks, documentation audits and clinical validation to ensure billing support and audit-readiness.
Detailed metrics on claim cycles, denial rates, vaccine billing, collections performance and revenue per provider.
Gather patient demographics, insurance & benefit details — including immunization coverage and preventive care eligibility.
Capture visit notes, immunization records, growth metrics, developmental assessments, and apply correct age-appropriate codes.
Submit claims electronically or via payer-specific formats, ensuring all documentation and modifiers comply with pediatric insurance rules.
Post remittances, co-pays, patient payments; reconcile adjustments and denials.
Analyze denials, correct coding or documentation issues, resubmit, or appeal to recover revenue.
Deliver financial and operational reports; identify trends and recommend workflow improvements.