Pediatric Billing Services for Massachusetts & Rhode Island Practices

Revenue cycle support for established pediatric primary care practices, built around how pediatric practices actually run.

RevCycle Rx provides billing and revenue cycle services within client Epic environments.

What we handle

Eligibility and benefits verification assistance & training
Coding and claim submission
Denial management and appeals
AR follow-up
Documentation review and compliance feedback

Soft watercolor-and-line-art pediatric office front desk check-in scene from the patient side, featuring a tablet on a stand, a neat stack of insurance member ID cards, a glass jar of colorful stickers, and a small service bell on the counter, with a softly blurred waiting area behind it containing kid-sized chairs, a toy bin, and a bookshelf; calm bright professional mood in navy, soft blue, gold, sage, and cream tones, with no people, no laptop, no plant, and no visible text

Credentialing maintenance available on request.

Built for pediatric billing

Pediatric claims have their own traps: well and sick visits on the same day, vaccine administration, developmental and behavioral screenings, an abundance of confusing modifiers, and payer-specific rules that change by plan. We know where pediatric revenue leaks, and we close the gaps before claims go out.

When a child has more than one plan

Many pediatric patients are covered by both parents' plans, and Medicaid is often in the mix too. Complicated custody arrangements, stepparents who add children to their own plans, and mid-year plan changes make it even harder to know who pays first. When the plans are billed in the wrong order, claims deny, payers take money back months or even years later, and families get bills they shouldn't.

We don't stop at determining which plan pays first. We work directly with families: we explain how their plans coordinate, what can happen down the road if it's ignored, and make sure they call each plan to update their records. Then we follow it until it's resolved.

Soft watercolor-and-line-art pediatric well-visit scene in a bright exam room with a pediatrician seated at a small desk using a laptop while talking with a parent holding a smiling toddler with a small stuffed animal, plus a wall growth chart, potted plant, and daylight from a window, in navy, soft blue, gold, sage, and cream tones

Payers we work with

MassHealth Blue Cross Blue Shield Harvard Pilgrim Tufts Health Plan Mass General Brigham Health Plan WellSense Health New England Fallon Health Aetna Cigna UnitedHealthcare TRICARE CHAMPVA Neighborhood Health Plan of Rhode Island Rhode Island Medicaid

Frequently Asked Questions

Which EHR do you use?

RevCycle Rx provides billing and revenue cycle services within client Epic environments. Our founder has worked with healthcare organizations' Epic systems since 2020. If your practice uses a different system, we're glad to learn it.

Do you take over all of our billing, or work with our staff?

Either. We can manage your full billing or work alongside your existing team, depending on your practice's size and needs.

Start Your Pediatric Billing Inquiry