Pediatric EHR and AI Medical Billing Software

Pediatrics runs on well visits, vaccines and sick visits, with a parent as the account holder. XEHR is set up for the way children are cared for and billed.

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Chart · Office visit

Lastname, Firstname M. Sample patient · DOB 01/01/1980 · Commercial

Eligible

BP128/82

HR72

BMI26.4

Temp98.6

Progress noteAI Scribe draft

Well-child visit, age four.

Z00.129 Well-child exam, normal

ReviewSign note

Diagnosis carried to the claimZ00.129

THE HARD PARTS

What makes pediatric billing hard

Well visit and sick visit together

A problem addressed at a well-child visit is billed separately only when documented separately.

Vaccines and their counseling

Each vaccine and its counseling is billed, and missing one line loses real money across a year of visits.

The parent pays, the child is the patient

Statements, balances and consent belong to a guardian, not the patient.

WHERE THE WORK HAPPENS

How pediatric care is delivered and billed

General pediatrics is office-based and built around the well-child schedule, vaccines and same-day sick visits, with newborn care in the hospital for many practices. Visits are billed on the professional claim to Medicaid, CHIP or commercial plans, and the person responsible for the bill is usually a parent rather than the patient. Vaccines supplied through the Vaccines for Children program change what can be billed for each shot.

What payers check on pediatric claims

For vaccines from the Vaccines for Children program, the practice bills the administration but not the vaccine itself.
A sick problem handled at a well visit is billed separately only when it is significant and separately documented.
Developmental and other standardized screenings are billed per instrument when the result is documented.
Well-child visit frequency follows the plan’s periodicity schedule, so an extra visit too soon is denied.
The guarantor on the claim is the parent or guardian, not the child.

Common pediatric diagnoses ICD-10-CM

Z00.129	Encounter for routine child health examination without abnormal findings
Z23	Encounter for immunization
J06.9	Acute upper respiratory infection, unspecified
H66.90	Otitis media, unspecified, unspecified ear
J02.9	Acute pharyngitis, unspecified
R50.9	Fever, unspecified

Examples only. The provider chooses the code that matches the documented diagnosis, and XEHR checks it against the note and the payer's rules before the claim goes out.

A VISIT ON XEHR

A pediatric visit, start to payment

1
Check coverage and the guarantor

Coverage is checked before the visit, and the parent or guardian responsible for the bill is confirmed.
2
Well visit by age

Growth, development screening, counselling and the vaccines due for the child’s age are documented in the well-visit template.
3
Vaccines recorded

Each vaccine is recorded with lot, dose and whether it came from the Vaccines for Children supply.
4
Bill and report

The visit, screenings and vaccine administration go out on one checked claim; immunizations are ready for registry reporting.

How XEHR helps

From the pediatric visit to the payment

Growth and development in viewGrowth charts and milestones sit in the chart for each visit.
Vaccines documented for billingAdministered vaccines are recorded with the visit and carried to the claim.
Guarantor billingStatements and balances go to the responsible adult.
AI that waits for youThe AI drafts notes and prepares claims; your providers sign and your billers approve.

Claim · CMS-1500

Sample claimLastname, Firstname M. · DOS 03/04/2026

Scrub passed

Scrubbed
Submitted
Accepted
Paid

Service	Dx	Units	Charge
Office visit	E11.9	1	145.00
A1c test	E11.9	1	28.00
Total			173.00

ERA postedPayment applied, no re-keying

Agentic AI for pediatric

AI medical billing for pediatric practices

XEHR is an agentic EHR: AI agents do the administrative work around every pediatric visit, and your team approves what matters. How agentic AI works

Before the claim leaves

The claim-check agent looks for

For vaccines from the Vaccines for Children program, the practice bills the administration but not the vaccine itself.
A sick problem handled at a well visit is billed separately only when it is significant and separately documented.
Developmental and other standardized screenings are billed per instrument when the result is documented.
Well-child visit frequency follows the plan’s periodicity schedule, so an extra visit too soon is denied.

Around the visit

Agents run on their own

Coverage checked before each pediatric visit
The visit note drafted for the provider to sign
Insurance payments matched and posted
Open claims tracked, denials read and appeals drafted

People decide

Your team stays in charge

Providers sign every note
Billers approve every claim and appeal
Staff submit prior authorizations
Any check can be overridden, with a reason

BUYER'S GUIDE

Questions to ask before you choose a pediatric EHR

Ask every vendor, including us. The answers show whether a system was built for pediatric work or only adapted to it.

Ask us on a demo

Does the system record Vaccines for Children doses so only the administration is billed?
Are growth charts plotted automatically for age and sex?
Can a sick problem at a well visit be billed separately when it qualifies?
Is the parent or guardian recorded as the guarantor?
Can immunizations be prepared for state registry reporting?

QUESTIONS

Pediatric practices ask us

Does XEHR include pediatric growth charts?

Yes. Growth measurements are charted over time in the patient record.

Can XEHR bill a sick visit during a well-child visit?

Yes, when the note documents the problem separately.

Does XEHR record Vaccines for Children doses?

Yes. Each dose records its source, lot and dose, and the claim bills only what may be billed.

Can XEHR send immunizations to the state registry?

Yes. Immunizations are recorded in the format registries use, ready for reporting.

Does XEHR support school and sports forms?

Yes. Forms are produced from the child’s record.

Can XEHR record developmental screenings?

Yes. Instruments and scores are recorded and billed per screening.

How much does XEHR cost for a pediatric practice?

Pricing is published: $189 per provider per month for the Clinical plan, $449 per provider per month for the Practice Suite with billing, or 2.5% of collections for RCM as a Service. Month-to-month, with a BAA on every plan. See pricing.

How long does it take a pediatric practice to go live?

Small practices are usually live in 2 to 4 weeks, including setup, data migration and training. We agree the plan with you before you sign.

Related specialties

See all specialties

See XEHR set up for pediatric

A 30-minute walkthrough on a live test environment, with your specialty's templates and billing.

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