The recurring pediatric problem list
Immunization administration is the classic example. The vaccine product, the administration code, and the counseling code each have rules, and payers differ on which can be billed together. When one element is missing, the whole claim can sit.
Well-child visits create a second cluster: screening tools that were administered but not documented, vision or hearing components left blank, and problem visits folded into a preventive code without the modifier that separates them.
- Immunization product and administration coding across payers
- Well-child visit components and their required documentation
- Developmental and behavioral screening codes with valid instruments
- Medicaid managed-care plan variations and timely filing windows
A calmer month for the front office
Pediatric practices often have one person doing eligibility, authorizations, billing, and the phones. When a batch of immunizations denies, that person becomes the bottleneck for everything else.
We try to remove the predictable failures: eligibility checked before the visit rather than after, immunizations verified against the state program, and a short weekly review of denials by category so the same correction is not made twice.