Pediatric Billing Services in Florida| 99% Customer Retention
Florida pediatric practices lose revenue to a children’s insurance coverage system that is split across four separate programs. Transcure bills pediatric claims correctly under all the rules of Florida.
- Route claims correctly across Medicaid, MediKids, Florida Healthy Kids, and the CMS Plan.
- Bill every Child Health Check-Up with all ten required components documented.
- Report the exact vaccine product code and the administration code Florida Medicaid requires.
- Catch SMMC plan filing windows that close months before the state limit.
- Meet s. 627.64194 balance billing limits and No Surprises Act rules.
Our Success in Numbers
Trusted by
500+ Physicians
Catering to
40+ Specialties
1100+ Certified
Medical Billers & Coders
End-to-End
RPA Billing Solutions
Up to 98% First Pass
Clean Claim Rate
Which Billing And Coding Errors Cost Florida Pediatric Practices?
Florida pediatric practices lose money to four billing failures created by the state’s four-program structure for children’s coverage.
- KidCare Premium Lapses Finish Coverage Mid-Treatment: MediKids and Florida Healthy Kids require a monthly premium before coverage starts. Nonpayment ends the insurance coverage, and the visit becomes self-pay. Our AI agents recheck KidCare status before every appointment, not only at intake.
- Claims Sent to the Wrong KidCare Program: Florida KidCare covers four programs with different payers and different rules. A child can move between Medicaid, MediKids, and Healthy Kids at renewal. We verify program placement and plan assignment before the charge posts.
- Incomplete Child Health Check-Ups: Florida Medicaid requires ten components in every Child Health Check-Up. A missing blood lead test or developmental assessment makes the screening non-reimbursable. Our AI agents validate each component before submission.
- SMMC Plan Filing Windows That Close Early: Florida Medicaid fee-for-service allows twelve months from the date of service. SMMC plan contracts often cut that to 180 days. Practices file under the state rule and lose the claim. Transcure tracks each plan’s window separately.
Pediatric Practices That Have Put Trust In Transcure
Pediatric practices choose Transcure to stop losing revenue. Our team owns end-to-end submission, denial work, and posting. We work with the prominent practices of pediatrics in USA:
What Services Transcure Offers for Pediatrics Billing in Florida?
Transcure covers every stage of the pediatric revenue cycle for Florida practices. Certified coders and AI agents work together at each step.
Insurance Eligibility Verification
Our ELIXA AI agent checks Medicaid, MediKids, Florida Healthy Kids, CMS Plan, and commercial coverage before each visit. Eligibility denials stop before the child arrives.
Prior Authorization and Treatment Validation
Our PRIA AI agent files and tracks authorizations across all SMMC plans, while treatment starts on schedule while protecting your revenue from being forfeited to insurance denials.
Pediatric Coding and Charge Capture
The CODIN AI agent works alongside certified coders on every check-up, immunization, newborn service, and sick visit. Each claim carries the correct CPT, ICD-10, and modifier combination.
Pediatrics Denial Management and Appeals
Our DEXA AI agent tracks trends across Sunshine Health, Simply Healthcare, Humana, Molina, and Aetna Better Health. Appeals go out with documentation attached inside each plan’s dispute window.
Florida Regulatory Compliance
Florida billing runs on state statute, not federal rules alone. Our compliance team applies s. 627.64194 balance billing limits and s. 641.3155 prompt pay deadlines to every claim, then pursue interest when plans pay late.
Transparent Pricing & Fast Onboarding
Your practice pays 5% of collections and carries no fixed staffing cost. Transcure works with 40+ EHR systems already in use. Billing goes live within 5 to 7 business days.
Which Cities Does Transcure Support with its Florida Pediatric Billing Services?
Transcure bills for pediatric providers in all nine SMMC regions and every major Florida city. Practice size does not change the work and outcome and the Solo clinics and multi-site groups get the same coders and the same AI agents.
Jacksonville, Florida
Miami, Florida
Tampa, Florida
View All Cities
Orlando, Florida
St. Petersburg, Florida
Port St. Lucie, Florida
Cape Coral, Florida
Hialeah, Florida
Tallahassee, Florida
Fort Lauderdale, Florida
How Does Transcure Handle Florida Medicaid and KidCare Claims?
Transcure identifies which Florida KidCare program covers a child, then bills that program under its own rules. Florida KidCare spans four programs: Medicaid for lowest incomes, MediKids for ages one through four, Healthy Kids for ages five through eighteen, and the CMS Health Plan for children with special health care needs.
ELIXA verifies placement and premium status before every visit, since missed premiums end MediKids and Healthy Kids coverage. SMMC 3.0 has run nine regions since February 1, 2025, with six plans contracted through 2030. The CMS Health Plan moves from Sunshine Health to Molina Healthcare on October 1, 2026, and we handle credentialing and claim routing for both.
Which Cities Does Transcure Support with its Florida Pediatric Billing Services?
Transcure bills for pediatric providers in all nine SMMC regions and every major Florida city. Practice size does not change the work and outcome and the Solo clinics and multi-site groups get the same coders and the same AI agents.
Miami-Dade County
Broward County
Palm Beach County
Orange County
Hillsborough County
Pinellas County
Nationwide Pediatrics Billing Support by Transcure
Pediatric practices across the nation trust Transcure for accurate CPT coding, claim submissions, and faster reimbursements.
What Types of Procedures Does Transcure Handle With Their Pediatric Billing Services?
Transcure bills the full range of pediatric procedures performed across Florida practices, from routine check-ups to hospital-based newborn services.
Newborn Hearing and Metabolic Screening Billing
Florida requires newborn hearing and metabolic screening to be completed before hospital discharge. Therefore, we bill both the technical and professional components correctly every single time.
Immunization and Vaccine Administration Billing
Florida Medicaid pays specifically for administering the vaccine, not for VFC-supplied doses. To avoid the claim rejection issues, we report 90460, 90461, and 90471 with accurate component counts.
Newborn and Nursery Care Billing
Newborn services typically cover initial hospital evaluation, daily nursery visits, and discharge day. Our coders carefully match every service to its correct corresponding code. So, the claims are processed smoothly and paid correctly.
Developmental and Behavioral Screening Billing
Developmental, autism, and behavioral screenings pay separately from the standard check-up visit. The single verification step effectively stops one of the most common Florida denials. And the practices see fewer rejected claims.
Blood Lead Screening and Follow-Up Billing
Blood lead testing is a required component of the Child Health Check-Up. Transcure confirms the result or a documented refusal present in the chart, then bill the screening and any follow-up testing.
Chronic Care and Asthma Management Billing
Asthma, obesity, and ADHD follow-ups create steady clinic visits. We accurately code every appointment's complexity and challenge insurance downcoding on appeal to protect your full reimbursement.
Our Comprehensive Pediatric Billing Audit Services
Delayed payments, claim rejections, increased administrative work, and regulatory risks results in $100,000 to $150,000 loss every year in pediatric practice collections. Providers don’t know, but they can save this money if they run professional practice audits twice a year, as these expert audits help them identify potential errors in their RCM before they cause any revenue loss.
To help pediatric practices and centers save money and avoid denials, Transcure pediatric billing company provides complimentary pediatric billing audit services with complete RCM. Contact us and let our professionals identify all the problems in your RCM before it’s too late.
Why Should You Outsource Pediatric Billing in Florida to Transcure?
Florida pediatric practices lose revenue to the KidCare program, plan filing windows, and immunization coding errors. Transcure handles all three with AAPC certified billers who work to improve the revenue.
Florida KidCare and SMMC Expertise
Our certified billers identify which regional plan holds the current contract for that child. As a result, claims to Sunshine Health, Simply, Humana, and Molina go out correctly the first time.
CMS Plan Transition
The CMS Health Plan will change administrators starting October 1, 2026. Consequently, practices serving children with special health care needs face new contracting requirements. To ease this shift, we manage both payer relationships throughout the entire process.
Accurate Immunization and VFC Coding
Immunization coding plays a major role in driving your pediatric revenue forward. That’s why we carefully bill 90460 and 90461 using correct component counts every time. Furthermore, we reconcile your VFC stock against administration claims on a monthly basis.
Clean Claims on First Submission
Your claims pass on the first submission 98 percent of the time. Specifically, CODIN checks modifier 25 pairings alongside age-based CPT edits for every claim. Meanwhile, NCCI conflicts get identified and resolved before anything reaches the payer.
How Does Transcure Protect Revenue During the CMS Health Plan Transition?
Currently, Sunshine State Health Plan operates the CMS Health Plan through September 30, 2026. Afterward, Molina Healthcare takes over statewide coverage the very next day. Fortunately, every current member transitions automatically, and existing prior authorizations carry over smoothly.
However, the real revenue risk sits within the claims themselves. The dates of service before October 1 belong to one payer entirely. Meanwhile, dates after that belong to an entirely different payer. As a result, split-date encounters, late charges, and corrected claims often cause revenue loss.
To prevent this, Transcure maps every open claim to its correct payer beforehand. Simultaneously, we confirm Molina contracting and credentialing in parallel.The aged claims get cleared against Sunshine before the transition window narrows.
Which Pediatric Billing EHRs Does Transcure Support?
Transcure works inside more than 40 EHR platforms, including platforms built specifically for pediatrics.
Trusted by Pediatric Practices Nationwide
Pediatric groups rate us among the best medical billing companies, and the reviews on every major platform reflect it. Pediatric groups rate us among the best medical billing companies, and the reviews on every major platform reflect it.
What Medical Practices Benefit From Transcure?
See the real financial impact of our pediatric billing services through our client testimonials and case studies.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Frequently Asked Questions
What Is the Best Pediatric Billing Company in Florida?
Transcure ranks among the top pediatric billing companies in Florida with a 98 percent first-pass clean claim rate. We bill Medicaid, MediKids, Florida Healthy Kids, the CMS Plan, and commercial payers.
How Much Our Pediatric Billing Services Cost in Florida?
Five percent of monthly collections, with no setup fee and no long-term contract. Most Florida billing companies charge four to eight percent. You pay only on the money we actually collect. No fixed staffing cost sits on your books.
How Long Does Florida Medicaid Give a Pediatric Practice to File a Claim?
Twelve months from the date of service under fee-for-service rules. SMMC plan contracts frequently shorten that to 180 days. The plan window governs for enrolled children, not the state window. We track each plan’s deadline separately so nothing ages out.
What Happens to CMS Health Plan Claims After October 1, 2026?
Molina Healthcare takes over the CMS Health Plan statewide on that date. Sunshine State Health Plan handles dates of service through September 30, 2026. Existing prior authorizations carry over. We route claims by date of service so payment continues through the transition.
Do You Handle SMMC Plan Credentialing for Pediatric Practices?
Yes. We enroll and credential your providers with Sunshine Health, Simply Healthcare, Humana, Molina, Aetna Better Health, and Community Care Plan. Each plan requires a separate contract in each region where you practice. We track every one.
Pediatric Billing Knowledge Center
Explore the latest Pediatric billing insights to enhance practice performance and profitability.
07/20/2026
Complete pediatric ICD-10 code guide: Z00.121 vs Z00.129, age gates, growth, behavioral and chronic codes, plus the CARC fixes that stop specificity denials.
08/24/2026
Pediatric CPT codes decoded: age-banded well visits, 90460 component counting, modifier 25 placement, and the new 2026 counseling codes 90482 to 90484.
08/24/2026
Complete pediatric ICD-10 code guide: Z00.121 vs Z00.129, age gates, growth, behavioral and chronic codes, plus the CARC fixes that stop specificity denials.