Denial
Healthy Louisiana plan mismatch
Root cause in New Orleans
Child switched managed-care plans
How we close it
Eligibility run at every encounter
Pediatric billing · New Orleans, LA
Pediatric billing services in New Orleans are, more than almost anywhere, a Medicaid operation, and 247 Medical Billing Services (247MBS) runs that revenue cycle so children's practices actually collect.
Since 2005 we have billed well-child, immunization, and newborn claims for Louisiana pediatricians, filing to the Healthy Louisiana managed-care plans and LaCHIP that cover the large majority of the city's children. Every client gets a dedicated account manager and a free 360° dashboard, and we stay HIPAA-compliant and SOC 2 Type II certified across Orleans and Jefferson parishes.
You cannot bill pediatrics in New Orleans without treating managed Medicaid as the main event. Louisiana covers a very high share of its children through Medicaid, delivered almost entirely by the Healthy Louisiana managed-care plans, with LaCHIP extending coverage to families just above the Medicaid line. For a New Orleans pediatric practice that means the everyday well-child and vaccine visits — the core of the business — are being adjudicated by managed-care organizations, each with its own eligibility portal, EPSDT documentation expectations, and vaccine administration edits. Eligibility is fluid: children move between Healthy Louisiana plans, cycle off and back onto coverage, and a claim filed to last quarter's plan simply denies. Because so much volume rides on these plans, the discipline that matters is not chasing large balances but making sure every routine EPSDT well-child and immunization claim goes out clean to the child's active plan. A billing company built for commercial adult claims consistently underestimates how much of the work here is Medicaid eligibility and EPSDT compliance, which is exactly where a New Orleans practice's revenue is won or lost.
Clean coding on the front end is what keeps that managed-Medicaid volume moving. A single well-child appointment often stacks a preventive visit, several vaccine lines, a developmental screen, and a same-day sick problem, and each layer has to match the child's specific Healthy Louisiana plan rules.
| Service line | Codes | What must be true to pay |
|---|---|---|
| Preventive, new patient | 99381–99385 | Age band matches the child's date of birth |
| Preventive, established | 99391–99395 | Correct band; periodicity respected |
| Well visit plus sick, same day | 99202–99215 + modifier 25 | Separate acute problem documented |
| Vaccine admin with counseling | 90460 / 90461 | First and each-additional component counted |
| Vaccine admin without counseling | 90471–90474 | Billed only when no counseling is provided |
| VFC state-supplied vaccine | admin + SL modifier | State stock, administration line only |
| Newborn care | 99460–99463 | Correct site; 99464 / 99465 billed separately |
| Developmental / behavioral screen | 96110 / 96127 | Reported separately, not bundled |
Practices choose to outsource when the front desk can no longer verify Healthy Louisiana plans, reconcile VFC, and work denials in the same day. As a dedicated pediatric billing company, we own the full cycle: eligibility, coding, claim scrubbing, submission within 24 hours, and denial recovery. Our results hold up across the parishes — a 99% first-pass clean-claim rate, up to 40% fewer denials, 90% of worked denials recovered, and A/R days kept under 25. We are a medical billing services company that runs pediatrics as a specialty line, with professional coders who know Louisiana Medicaid and its managed-care plans rather than treating children's claims as an afterthought.
Outsourcing also gives New Orleans practices clean service handoffs instead of one overloaded biller. Clients rely on our eligibility and verification, denial management, and pediatric credentialing so a new provider is paneled with the Healthy Louisiana plans before the first claim goes out. For the full overview, see our pediatric billing hub; for statewide payer detail, see medical billing in Louisiana. As a billing services company built around children's care, our 98% client retention reflects how much that specialty focus matters in a Medicaid-heavy market.
Revenue review
A certified pediatric billing specialist reviews your coding, unit counts, authorizations and aged A/R against the payers you actually bill in New Orleans, LA — and puts a number on what your current process is leaving on the table.
A pediatric specialist will reach out within one business day.
A pediatric specialist will reach out within one business day.
Given how much rides on managed Medicaid, the denials that hurt are the routine ones — well-child and vaccine lines undone by a plan mismatch or a missing modifier, at high volume.
Healthy Louisiana plan mismatch
Child switched managed-care plans
Eligibility run at every encounter
Modifier 25 rejected
Same-day sick problem not separated
Documentation check before submission
Immunization admin error
90460 component miscount vs 90471
Coder-verified vaccine logic
VFC billing denied
SL modifier missing on state vaccine
Vaccine-source scrubbing rule
EPSDT off schedule
Well-child outside the periodicity schedule
Bright Futures schedule enforced
Timely filing lapse
Plan deadline missed in an A/R backlog
24-hour submission workflow
We bill for solo and independent pediatricians, multi-site pediatric groups, and pediatric urgent care from Uptown and Mid-City out to Metairie, Kenner, Gretna, Chalmette, and across the lake to the North Shore. That includes newborn and hospitalist pediatric services tied to Children's Hospital New Orleans and the LCMC Health system, high-volume vaccine clinics, practices carrying heavy Medicaid and LaCHIP panels, and offices adding a clinician who needs fast managed-care credentialing before that provider can bill a single visit. Whether your panel is almost entirely Healthy Louisiana or a commercial-leaning suburban mix, we tune the workflow to how your patients are actually covered rather than forcing a one-size template onto pediatric claims.
New Orleans pediatric practices protect their largest revenue source when 247MBS runs the cycle end to end. We handle medical billing for pediatric in New Orleans from eligibility through payment, confirming each child's active Healthy Louisiana plan or LaCHIP coverage, coding EPSDT well-child and vaccine visits to that plan's rules, and filing within 24 hours so nothing slips past a deadline. Because so much of the city's children's care rides on managed Medicaid tied to Children's Hospital New Orleans and the LCMC Health system, we build the workflow around EPSDT periodicity and VFC administration rather than a generic template. Across our clients that discipline holds a 99% clean-claim rate with A/R days under 25. Request a revenue review and recover the routine visits that quietly deny.
New Orleans practices are billed out of the same Louisiana desk. Statewide payer detail lives on the Louisiana page.
Outsourcing Pediatric Billing Services — the codes, unit rules and denials nationally, without the local layer.
Yes. We verify the child's active Healthy Louisiana plan before every visit and file EPSDT well-child and immunization claims to the correct plan, which is where most New Orleans pediatric denials originate. Plan switches get caught at eligibility, not at denial.
Yes, and it is one of the most common pediatric fixes we make. We confirm the same-day sick problem is separately documented before submission, so both the well visit and the problem E&M get paid.
We do. We bill VFC administration with the SL modifier and align well-child claims to the Bright Futures periodicity Louisiana's EPSDT program follows, so state-supplied vaccines and preventive visits both pay correctly. In a market where most children are Medicaid-covered, keeping that administration billing clean protects a large slice of monthly revenue.
From solo practices to multi-provider groups, we bill Pediatric for New Orleans practices with a dedicated account manager, certified coders and a live dashboard — so the units, authorizations and appeals that decide your month stop being the thing nobody has time for.
Prefer email? sales@247medicalbillingservices.com