Pediatric billing carries rules, frequency limits, Medicaid TPL, age restrictions, and coordination of benefits that general dental billing doesn't run into. Our pediatric billing services handle those rules so claims get submitted correctly and your practice collects steadier cash flow across hundreds of young patients.
Pediatric dentistry runs on volume. You see more patients in a day than most general practices, and every one of them comes with a parent, an insurance plan, and sometimes two. Add Medicaid and CHIP rules that vary by state, frequency limits on preventive visits, and the coordination of benefits when a child is covered by both parents, and the billing gets complex fast. One overlooked frequency limit or missed coordination of benefits and the claim comes back unpaid. Billdontix manages your pediatric revenue cycle, so your front desk isn't stuck untangling insurance while a waiting room full of kids gets restless.
Pediatric dental billing is the process of submitting claims for dental care delivered to children, across Medicaid, CHIP, and commercial insurance plans. It involves verifying coverage, tracking frequency and age restrictions on preventive services, coordinating benefits when a child is covered by multiple parents' plans, and following payer-specific documentation requirements.
Because pediatric payers, especially Medicaid and CHIP, have different rules in each state, billing this well takes specialists who know both the codes and the payer variation.
Pediatric billing carries specific gaps that are easy to miss but compound fast when you're seeing dozens of children a day.
State Medicaid programs are strict. Wrong fee schedule, missing prior auth, a service billed outside the covered frequency, and it's denied. The reimbursement is already tight, so an unworked denial is a loss you cannot afford. We know the state rules, bill to them, and appeal what gets kicked back.
Kids covered under both parents are common. Determining which parent's plan is primary, and submitting to both in the right order, is where many practices trip. Get primary and secondary in the wrong order and both payers push the claim back. We verify COB rules up front and bill in the order each plan requires, though the exact rules vary by plan and state.
Prophylaxis, fluoride, exams, and sealants all carry frequency and age restrictions that differ by plan. Schedule a recall a little too soon and the claim bounces. We verify these limits before the visit so the appointment gets submitted within the plan's rules, though final approval is determined by the payer.
Nitrous, oral sedation, general anesthesia, and protective stabilization are routine in pediatrics and heavily scrutinized by payers. Thin documentation gets them denied. For cases with documented medical necessity, billing sedation to medical insurance can unlock additional reimbursement. We bill these with the clinical narratives and supporting records each payer requires, though the treating dentist creates and approves the clinical documentation.
After insurance pays, someone still has to explain the remaining balance to a parent. Statements pile up, balances age, and nobody at the front desk has time to chase them. We handle statements, balance follow-up, and billing questions so those dollars don't just sit there.
A comprehensive suite of custom revenue cycle workflows built from the ground up for pediatric practices.
Before the appointment, we verify Medicaid, CHIP, and commercial coverage, check frequency and age limits, confirm remaining benefits, and sort out coordination of benefits for dual-covered kids. Your team quotes the parent an accurate number the first time.
We bill to your state's fee schedule, handle prior authorizations where required, and submit the documentation each program requires. When a claim gets denied, we work it. Final coverage decisions rest with each state program and payer.
We establish which parent's plan is primary, bill in the right sequence, and pursue the secondary claim so the full covered amount gets collected where both plans allow it. Rules vary by plan and state.
Every claim is reviewed against current ADA guidelines before it goes out, with accurate coding for preventive care, restorative work, pulpotomies, crowns, space maintainers, and sedation. The treating provider creates and approves clinical records; we ensure claims match those records accurately.
Denied claims get worked the same week. We find the cause, correct it, attach the documentation, and appeal where the denial is appealable.
We post insurance payments, reconcile them against your fee schedules to catch underpayments, then send clear statements and follow up on outstanding parent balances.
We work inside your existing systems, so access and data handling matter. Our access is set up to protect your practice and your patients:
Your data stays yours. You keep full ownership, visibility, and control throughout.
We keep pricing tied to results and spelled out up front:
You pay a share of the revenue we collect on your behalf.
Results
tied to actual collections
Fees apply to insurance and patient payments we help bring in.
Defined
before you start
You work with one billing specialist who learns your payers, your state's Medicaid and CHIP rules, and your workflow. No call center, no tickets, no starting over with someone new.
Our billers hold AAPC, AHIMA, and CCS certifications and know pediatric billing specifically: Medicaid programs, COB rules, sedation documentation.
We log into your practice management system remotely using role-based access, individual logins, and audit logs, under the controls described above. You keep your data and your team keeps its routine.
We work month to month. If we're not earning it, you're free to leave with no penalty.
The free audit gives you a clear read on your pediatric billing. You'll see:
The free audit gives you a clear read on your pediatric billing. You'll see how your recent claims were coded, where verifications were missed, and what's recoverable.
Book Your Free AuditOnboarding takes days, and we work inside the system you already use. Once we're on, eligibility gets checked before the visit instead of after the denial, Medicaid and CHIP claims go out clean, and denials get worked instead of stacking up. Your front desk stops playing insurance detective. Parents get statements they can actually read. And you get straightforward monthly reporting on collections, denials, and receivables so you know where the practice stands.
We work inside the system you already use. Onboarding takes days, not weeks.
Eligibility gets checked before the visit. Medicaid and CHIP claims go out clean. Denials get worked instead of stacking up.
Straightforward monthly reporting on collections, denials, and receivables so you know where the practice stands. We also coordinate with the treating provider on clinical documentation.
You don't have to switch anything. We work securely inside the practice management software you already use, including Dentrix, Eaglesoft, Open Dental, Curve Dental, and Carestream, under the access controls described above, and we fit into your existing workflow without slowing your team down.
Book a free audit. We'll review how your pediatric claims are being coded and billed, show you where denials and missed verifications may be costing you, and lay out what looks recoverable, along with the pricing terms for your practice.
Yes. Medicaid and CHIP make up a large share of pediatric dental revenue. We bill both according to each state's fee schedule, get prior authorizations where required, and submit the documentation each program asks for. Final coverage decisions rest with each state program and payer, but we work denials rather than write them off.
We determine which parent's plan is primary and which is secondary based on each plan's COB rules, bill that plan first, then submit to the secondary plan for the remaining balance. The exact rules vary by plan and state, so we verify the order before the claim goes out.
Yes. Nitrous oxide, oral sedation, general anesthesia, and protective stabilization are routine in pediatric dentistry, but they are heavily scrutinized by payers. Thin clinical documentation gets them instantly denied. For cases with documented medical necessity, billing sedation to medical insurance can unlock additional reimbursement.
We check them before the appointment. Plans limit how often preventive services like prophylaxis, fluoride, exams, and sealants can be billed, and those limits vary by plan and state. Verifying ahead of time keeps recall visits from getting denied over a technicality.
Yes. After insurance pays, we send clear statements, follow up on outstanding balances, and field billing questions from parents, so your front desk isn't stuck doing collections between patients.
No. We work securely within your existing practice management system using role-based access, individual logins, and audit logs. You keep full ownership of your data, with no migration and nothing new for your team to learn.
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