Pediatrics Medical Billing Services in New York, NY

Expert in NY Medicaid, CHIP, and Vaccine Billing Rules
Avoid 23% Denial Rates with Pediatric-First Scrubbing
Age-Specific Coding for Well Visits & Immunizations
Handle Prior Auths for Therapies, Labs & Procedures
Reduce Admin Load with Outsourced Pediatric Billing
Real-Time Pediatric KPIs via Secure Billing Dashboard

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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

Why Pediatric Billing is Harder in 2025 Than Ever Before?

In 2025, New York pediatricians are juggling:

Low Medicaid rates with high documentation burdens
SPARCS and surprise billing laws that change quarterly
Parents with HDHPs asking, “Why am I getting a bill for a well visit?”
AI-driven payer reviews, flagging minor errors for audit

Most front office staff are not equipped to manage these complexities, billing departments are overwhelmed, and collection performance is steadily declining.

How Pediatric Billing Rules in New York Create Revenue Risk for Practices?

Pediatric billing rules in New York are complex due to the combination of rapidly changing codes, strict Medicaid regulations, and intricate state laws, all of which contribute to increased denials and delayed payments. Vaccine schedules shift regularly. NY Medicaid demands line-item detail for well-child visits. VFC vaccine claims are denied if admin fees or inventory aren’t logged perfectly. Parental consent is required for many services, and without it, reimbursement is blocked. Denials have jumped 23% in New York alone.

If your pediatric billing process hasn’t evolved in the last year, you’re likely losing thousands in delayed payments, denied claims, and unrecovered A/R.

We Specialize in Pediatric Billing. In New York. For Practices Like Yours.

Here’s what we fix, from day one:

Age-Based CPT/E/M Coding — G2211, 90460, 99392? Nailed.
Vaccine Billing with VFC Inventory Tracking — Clean, compliant, and fast.
Medicaid & CHIP Expertise — We know every managed care plan in NY.
Prior Authorization Management — No more denied therapy visits.
Denial Prevention — Our claim scrubbers catch issues before submission.
NY Compliance — From consent forms to SPARCS rules, we’ve got you covered.
Transparent Dashboards — Know exactly what’s paid, pending, or denied, 24/7.

Cities Served by Transcure Pediatric Billing Services in New York

New York City

Buffalo

Rochester

View All Cities

Yonkers

Syracuse

Albany

New Rochelle

Mount Vernon

Schenectady

Which Billing Metrics Matter Most to Pediatricians in New York?

98.3% Clean Claim Rate
A/R Days: 24 (NY Average: 42)
42% Denial Reduction in First 90 Days
Multiple Pediatric Practices Served in NYC, Westchester & LI
95% Satisfaction from Practices Billing Medicaid

Partner with a medical billing company trusted by pediatricians across New York to streamline revenue, ensure compliance, and support practice growth.

Counties Served by Transcure Pediatric Billing Services in New York

Kings County (Brooklyn)

Queens County

New York County (Manhattan)

Suffolk County

Bronx County

Nassau County

Westchester County

Erie County

Monroe County

Pediatric Billing Services with Nationwide Reach and Local Precision

Along with supporting Pediatrics practices in New York, Transcure also delivers expert billing services to other states nationwide. Our team understands the unique documentation and reimbursement challenges Pediatrics providers face all across the country.

What are the Attributes of a Pediatric Medical Billing Company in New York?

Vaccine Billing Optimization for New York Practices

We automate vaccine billing workflows, track VFC inventory, and prevent errors in admin fee claims to ensure full reimbursement.

Pediatric EHR Integration Across New York

We integrate with pediatric-friendly EHRs like PCC, eClinicalWorks, and Office Practicum to ensure accurate age-based coding and visit documentation.

Child-Specific Quality & Medicaid Reporting

We support pediatric-specific SPARCS data, HEDIS child health metrics, and MCO reporting to meet NY Medicaid standards.

Consent & Compliance Aligned with NY Pediatric Laws

Our workflows ensure compliance with NYS parental consent requirements for screenings, behavioral care, and adolescent visits.

Supporting a Full Spectrum of Specialties Alongside Pediatric Billing in New York

We cater to a wide range of specialties, spanning from primary care to surgical centers, serving small and mid-sized practices based in New York.

Our Success in Numbers

Value of claims processed

$ 1 M+

Accounts Receivable Days

Turn Around Time (TAT)

1 Hours

Customer Retention

1 %

Number of Claims Processed

1 M

First Pass Clean Claims Rate

1 %

Revenue Improvement

5%- 5 %

Reduction in A/R

1 %

Why Choose Our Pediatric Billing Company in New York?

Choose our pediatric billing company in New York to give your practice a strategic edge, ensuring compliance, reducing denials, and unlocking missed reimbursements.

School-Based & EPSDT Billing Alignment:
We bill accurately for school-linked services and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits per NY Medicaid guidance.

Newborn & NICU Billing Precision
From APGAR-linked modifiers to transitional care codes and NICU claims, we handle the high-risk first-year billing with pediatric subspecialty accuracy.

Child Health Plus & Dual Coverage Navigation
We coordinate billing for families covered under NY’s Child Health Plus and commercial insurance, avoiding claim overlaps and eligibility denials.

Lead Screening & Public Health Reporting
We ensure proper billing and documentation for mandated pediatric lead screening and integrate with NYSIIS for immunization tracking and compliance.

Avoid In-House Pediatric Billing Risks, Partner with Transcure in New York

Handling billing in-house can result in costly coding errors, compliance gaps, and delayed payments, particularly in New York’s highly regulated environment. According to the HFMA, outsourcing can save practices between $50,000 and $150,000 annually. Transcure helps pediatric practices eliminate these risks through:

Seamless Eligibility Checks & Denial Management
Full Compliance with NYSDOH, CMS & SPARCS Regulations
Reduced Administrative Workload for Clinical Staff
Faster Reimbursements with AI-Powered Claims Scrubbing

We are adept at using these EHRs

The experts at Transcure are well-versed with the features
and workflows of your EHR system.

80% of Medical Claims Have Errors, Pediatric Practices in NY Are Especially Vulnerable

In 2025, national data revealed that 80% of pediatric medical claims contained coding or documentation errors, often related to vaccine billing, age-specific codes, or consent protocols. Without pediatric-specialized billing support, these errors result in higher denial rates, delayed reimbursements, and mounting administrative pressure, making expert pediatric billing services crucial for achieving sustainable financial performance across New York. 

Need a Pediatric Billing Services Provider with an Understanding of New York Billing?

Frequently Asked Questions (FAQs)

How does pediatric billing differ from general medical billing?

Pediatric billing involves using age-specific codes, adhering to vaccine schedules, and conducting screenings that require precise documentation and accurate modifier usage.

What are the New York-specific billing codes for pediatric vaccines?

New York follows CPT codes like 90460–90474 for vaccine administration, with state-specific requirements for VFC reporting and inventory tracking.

Can you bill both Medicaid and commercial for pediatric care in NY?

Yes, dual coverage billing is allowed, but it must follow coordination of benefits (COB) rules to avoid denials or overpayments.

What are the new NY consent laws for pediatric billing?

As of 2025, New York mandates documented parental consent for developmental, behavioral, and adolescent care services before billing can occur.

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