MedSynthea + Jane for Pediatrics Billing
Connect MedSynthea to Jane App via REST API to automate Pediatrics revenue cycle workflows end-to-end — from eligibility verification through CPT 99381-99395 coding and ERA payment posting, with 0% PHI in system logs.
Deploy Pediatrics Automation with Jane App in 4 Steps
REST API integration — no EHR vendor changes required.
Authenticate Jane App
Authorize MedSynthea via REST API. No vendor changes required — standard OAuth2/SMART credentials used.
Map Pediatrics Workflows
Configure CPT 99381-99395 (Preventive) + 90700s (Vaccines) fee schedules, payer contracts, and vaccine administration bundling prevention rules.
Activate AI Agents
9 agents begin processing Pediatrics encounters from Jane App: eligibility, coding, scrubbing, and claim submission.
ERA Write-Back
Approved payment data posts back to Jane App via REST API write-back, closing the billing loop automatically.
Pediatrics Revenue Cycle Challenges MedSynthea Solves in Jane App
Pediatrics billing is governed by CPT 99381-99395 (Preventive) + 90700s (Vaccines) coding complexity and strict payer LCD policies.
Vaccine administration bundling
Jane App practices in Pediatrics face repeated denials for vaccine administration bundling. MedSynthea reads clinical notes from Jane via REST API and flags documentation gaps before claim submission.
CPT 99381-99395 (Preventive) + 90700s (Vaccines)
MedSynthea's CODE agent validates all CPT 99381-99395 (Preventive) + 90700s (Vaccines) codes pulled from Jane App clinical documentation against NCCI edit tables and payer-specific modifier rules.
Pediatric practices leave up to $18,000 per year in uncollected vaccine administration fees due to improper CPT 90460/90461 bundling rules (AAP Practice Management Report 2024).
9 AI Agents Working Inside Jane App for Pediatrics
Each agent reads from and writes back to Jane App via REST API for a closed-loop Pediatrics billing workflow.
Scheduling Agent
Analyzes appointment patterns, flags high-risk no-show appointments, captures scheduling context (procedure type, referral source, insurance class) that affects downstream coding and billing decisions
In Jane: reads CPT 99381-99395 data via REST API
Eligibility Agent
Queries 900+ payer databases in real time, validates active coverage, extracts benefit-level details (co-pay, deductible, out-of-pocket), identifies coverage gaps and prior auth requirements before the encounter begins
In Jane: reads CPT 99381-99395 data via REST API
Documentation Agent
Converts encounter audio into structured clinical text using specialty-aware transcription models. Links every transcribed segment to the specific audio timestamp it came from, creating an immutable evidence chain. Formats output for the NOTE agent to structure into reviewable clinical documentation
In Jane: reads CPT 99381-99395 data via REST API
Coding Agent
Reads structured clinical documentation, applies specialty-specific ICD-10 hierarchies and CPT code families, validates against payer-specific LCD policies and NCCI edit tables, applies correct modifiers, and proposes a complete reviewable code set linked to the clinical evidence that supports each code
In Jane: reads CPT 99381-99395 data via REST API
Scrubber Agent
Scores every claim against 200+ denial variables before submission. Identifies modifier conflicts, missing prior authorizations, LCD coverage gaps, eligibility issues, and payer-specific policy violations. Routes high-risk claims for human review before they reach the payer, preventing denials at the source
In Jane: reads CPT 99381-99395 data via REST API
Prior Auth Agent
Identifies prior authorization requirements from eligibility data and payer rules, assembles supporting clinical documentation, submits PA requests via payer APIs or electronic portals, tracks approval status in real time, and routes approvals back to the clinical workflow and Billing agent
In Jane: reads CPT 99381-99395 data via REST API
Billing Agent
Submits validated claims to payer clearing houses or direct payer APIs, monitors submission acknowledgement in real time, tracks claim status through the payer adjudication process, flags abnormal hold times for follow-up, and passes accepted claims to the FLW agent for ongoing tracking
In Jane: reads CPT 99381-99395 data via REST API
Denial Agent
Receives denial notifications, categorizes each denial by type (clinical necessity, coding, eligibility, authorization), retrieves original claim and clinical documentation, identifies the specific correction needed, assembles an appeal package with targeted documentation, and submits the appeal via payer portal or mail within the payer's filing window
In Jane: reads CPT 99381-99395 data via REST API
Reconciliation Agent
Receives 835 EDI ERA files and EOB documents from payers, matches each payment line to the original claim, posts payments to the appropriate account, flags underpayments against contracted rates, identifies incorrect adjustment codes, calculates patient balance responsibilities, and generates reconciliation reports for financial review
In Jane: reads CPT 99381-99395 data via REST API
Other Specialties Supported in Jane App
MedSynthea automates all major specialties within Jane App via REST API.
Pediatrics Billing in Other EHR Systems
Jane App + Pediatrics Integration — Frequently Asked Questions
How does MedSynthea integrate with Jane App for Pediatrics billing?
MedSynthea connects to Jane App via REST API, reading clinical encounter data and writing approved CPT 99381-99395 (Preventive) + 90700s (Vaccines) codes and documentation back into the EHR automatically — without any custom software engineering.
Does MedSynthea support Jane App for Pediatrics prior authorization?
Yes. MedSynthea's PA agent reads Pediatrics encounter data from Jane App via REST API, assembles required clinical documentation, and submits prior authorization requests automatically for Pediatrics procedures.
What Pediatrics CPT codes does MedSynthea validate in Jane App?
MedSynthea's CODE agent validates CPT 99381-99395 (Preventive) + 90700s (Vaccines) against payer LCD policies and NCCI edit tables, then writes approved codes directly into Jane App with full evidence traceability — every code linked to source clinical notes.
How long does Jane App + MedSynthea setup take for a Pediatrics practice?
Most Pediatrics practices complete Jane App integration in under 2 weeks. MedSynthea authenticates via REST API — no EHR vendor code changes required. Configuration covers fee schedules, payer contracts, and Pediatrics-specific denial rules.
Connect Jane App to MedSynthea for Pediatrics Billing
Zero custom engineering. REST API authentication. Live Pediatrics automation in under 2 weeks.
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