Clientele's pediatric intelligence platform decodes vaccine coding, modifier 25 logic, developmental screening rules, and Medicaid complexity, so your practice gets paid accurately for every newborn visit, well check, and immunization you deliver.
Six recurring points of failure sit between a pediatric encounter and a clean claim.
CPT and CVX code pairs shift with every ACIP schedule update.
Well visits and sick visits on the same day require precise modifier logic.
M-CHAT, ASQ, and PEDS screenings each carry distinct billing codes.
Coverage and EPSDT requirements vary by state and by age band.
Hospital, circumcision, and initial newborn codes overlap in the first days of life.
Vaccine administration, counseling, and injections bundle differently by payer.
Billing logic changes at every milestone from birth to adolescence.
3–5 day, 2-week checks
Hep B birth dose
Hearing & metabolic panel
Global newborn care codes
Hospital-to-outpatient transition
2, 4, 6, 9-month visits
DTaP, IPV, PCV13, Rotavirus
ASQ-3 at 9 months
Multi-vaccine admin coding
EPSDT periodicity tracking
12–30-month visits
MMR, Varicella, Hep A
M-CHAT-R at 18 & 24mo
Screening + modifier logic
State EPSDT age-band shift
Annual well-child exam
School-entry series
School-readiness, vision
Sports physical bundling
School immunization mandates
Annual adolescent exam
Tdap, HPV, Meningococcal
PHQ-9, behavioral health
Confidential-services billing
Consent & coverage rules
Five modules validate every claim before it ever reaches a payer.
Cross-checks every immunization against current CVX and CPT pairs before submission.
Flags same-day well and sick visit claims that need modifier 25 or 24 logic.
Applies state-specific Medicaid and EPSDT periodicity rules automatically.
Confirms screening codes match the tool administered and the child's age band.
Predicts denials before submission using pediatric-specific claim patterns.
Select an age group to see how billing logic shifts at that stage.
"Our vaccine reimbursements went up almost a third within two quarters. Clientele's system understands the CVX-CPT relationship better than most of our coders did."
"Modifier 25 used to be our biggest denial source. It's now one of our cleanest categories."
"The Medicaid logic alone paid for the platform. EPSDT rules change constantly and this is the first system that keeps up."
Our engine syncs to the current ACIP immunization schedule and validates every CVX-CPT pairing before a claim is submitted, so schedule updates never become denials.
Yes. Clientele maintains state-specific EPSDT periodicity and coverage logic, applied automatically based on the patient's state and age.
Clientele's modifier review flags same-day visit claims and recommends the correct modifier before submission, reducing one of pediatrics' most common denial triggers.
The platform matches the screening tool administered (M-CHAT, ASQ, PEDS, or PHQ-9) to the appropriate code and the child's age band automatically.
No. Clientele layers on top of your existing PM and EHR, validating and enriching claims before they leave your system.
Most pediatric practices are fully live within 3 to 4 weeks, including payer-specific configuration.
