What to prepare before outsourcing dental billing
If you are at the point of considering outsourced dental billing, the main risk is not the work itself. It is the handover. Delays, confusion, and missed follow ups usually come from unclear access, undocumented routines, or too many people giving direction. Outsourcing runs smoother when you decide who owns the relationship on your side, write down how things are currently done, and are ready to provide the right logins and information from day one.
In this guide, “outsourced dental billing” means non-clinical, off-site support for insurance claim submission and follow up, patient billing follow up on balances, insurance verification (checking eligibility and coverage), and recare calls to help patients complete planned care. Before you choose a provider, it helps to prepare for how communication will work, what access is needed, and what you should expect in the first few weeks.
Clarify what you want outsourced (and what stays in-house)
Decide the split of duties before you speak to anyone, so there is one clear version of “who does what”.
Before you talk to a vendor, get specific about the work you want off your front desk. If you keep it vague, people fill in the gaps. That is when tasks get missed or duplicated.
A simple way to start is to sort your needs into four common service areas. Even if you only outsource one or two, naming them helps you scope the handover.
Insurance billing is claim submission and follow up. That includes sending claims to the insurer, tracking whether they were received, and working denials or requests for information. A “denial” is when an insurer refuses all or part of a claim and gives a reason.
Patient billing support is statements and balance follow up. In plain terms, it is keeping patient balances visible, communicating about what is owed, and following up until the account is resolved or a clear next step is agreed.
Insurance verification is eligibility and coverage checks. That means confirming the patient’s plan is active and what it is likely to cover for the planned visit. It is not a promise of payment, but it reduces avoidable surprises.
Recare calls are follow ups that help patients complete planned care. This is non-clinical outreach to encourage scheduling and keep care plans moving, based on the practice’s instructions.
Keep boundaries clear. Outsourced support should be non-clinical only. It does not include treatment advice or answering clinical questions. If a patient asks whether a procedure is necessary, or what option is best, that stays with your clinicians.
Some tasks usually stay in the practice because they depend on what happens chairside or at reception in the moment. Collecting at checkout is the obvious one. So are clinical coding decisions, because they rely on clinical notes and judgement. Patient clinical questions should also stay in-house, even if they come in through a billing call.
One small judgement call that helps: choose one internal owner for the outsourced work. Not a group. A single point of contact avoids mixed messages and makes it easier to keep the scope steady as things settle.
Decide your goals and how you will measure progress
Before you pick a provider, get clear on what “better” looks like in your day-to-day work, and how you will tell if it is happening.
Outsourcing only works smoothly when everyone is aiming at the same outcomes. Not vague ones like “improve billing”. Practical ones that relate to your current friction points.
Common goal types I see in practices are straightforward:
- Fewer claim delays, so claims move through submission, follow up, and responses with less sitting idle.
- More consistent follow up, so nothing relies on one person remembering to chase it.
- Cleaner handoffs between front desk, clinical team, and the billing function, so fewer “we thought you were handling that” moments.
- Improved patient communication consistency, so messages about balances and next steps sound the same whoever the patient speaks to.
Once you know the goals, pick a small set of measures. Keep it to what you already track, or what you could track without creating a new admin job.
Examples that tend to be useful:
- Claim status turnaround internally, such as the time from treatment date to claim submitted, and from payer response to your next action.
- Volume of unresolved insurance requests, like claims waiting on missing information or insurer follow ups you have not had a response to yet.
- Patient balance follow up ageing buckets, if you have them. This is simply grouping balances by how long they have been outstanding, such as 0-30 days, 31-60 days, and so on.
If you do not have these numbers today, that is not a deal breaker. It just means you should agree what will be tracked going forward and who will own pulling it together. Usually, one simple weekly snapshot is enough to start.
Set realistic expectations early. Timing depends on payer response times, how quickly your practice answers questions, and the quality of the information you provide up front. Even the best follow up cannot move a claim faster if the insurer is slow, or if the claim is missing attachments, narratives, or correct policy details.
One small judgement call that helps: prioritise measures that reflect controllable process, not just money. It keeps the conversation grounded and makes it easier to spot where the handoff is breaking down.
Map your current workflow before you change it
A simple map of who does what, and when, stops tasks being duplicated or missed during handover.
Before you outsource any part of billing, write down your current workflow as it actually happens. Not the version in a policy folder. Keep it light. A single page is often enough.
This is not about process theory. It is about avoiding two common transition problems: the practice and the outsourced team both doing the same follow up, or nobody doing it because each side assumed the other owned it.
Start where claims originate. In most practices that means procedures and fees are posted after the appointment, then a claim is created, then someone reviews it before it goes out. Note what triggers the claim creation. Is it automatic after posting, or does a team member create it at set times each day? Also note who checks it for basics like patient details, policy details, dates, and missing information before submission.
If you use the term “clean claim”, define it in one line for your own team. In plain terms, it means a claim that has the information the payer needs so it is less likely to be rejected for avoidable admin reasons.
Next, capture how attachments are handled. Attachments might include narratives (a short written explanation), EOBs (Explanation of Benefits from the insurer), or images such as X-rays. You do not need to detail any clinical content. What matters here is the admin path: who requests the attachment, where it is stored, how it is labelled, and who is responsible for sending it with the claim or in response to a payer request.
Be specific about timing. For example, do you gather attachments on the day of treatment, only when a payer asks, or only when a claim fails? Those choices change the workload and the handoffs.
Then map how patient balances are generated and when follow up begins. Patient balances can be created by underpayment from the insurer, a deductible, a co-payment, or a claim being denied. Note when your team becomes aware of the balance, and what starts follow up. Is it the posting of an insurance payment, a weekly report, or a patient calling in?
Also write down what “follow up” means in your practice. Does it start with a text, a call, a statement, or a note for the next visit? If there are rules, like waiting a set number of days after a statement, capture those as well.
Now place insurance verification into the scheduling flow. Verification is checking eligibility and coverage before the appointment, so you know whether the policy is active and what the plan says it covers. The key question is when it happens and for which appointments. For example, do you verify only new patients, only major work, or everyone on a rolling schedule? Note who requests missing policy details from the patient, and how far ahead of the appointment you aim to complete checks.
Finally, include recare follow up. Recare calls are non-clinical follow ups to help patients return and complete planned care or routine visits. Write down how patients are selected for contact today. Is it based on time since last visit, incomplete treatment plans, missed appointments, or a list the clinical team flags? Then note how you prioritise. For example, do you focus first on overdue patients, patients with planned treatment not booked, or patients who have not responded to previous reminders?
One small judgement call that helps: map exceptions, not every edge case. If you capture the top three exceptions that derail the day, like missing policy details, missing attachments, or unclear responsibility for a denial, you will prevent most of the confusion later.
Prepare the access an outsourced billing team will need
Agree what they can see and do, and keep control in the practice
Access is where most outsourcing handovers go wrong. Either the outsourced team cannot do the work, or they can see more than they should. The aim is “minimum necessary access” – only what is needed to complete the tasks you have agreed.
Start with a simple permissions plan. Exact access depends on your practice’s systems and your internal policies, so treat this as a checklist rather than a fixed set.
For claims submission and follow up, the outsourced team usually needs access to the areas where claims are created, edited, submitted, and tracked. They also need to see claim status messages, payer responses, and what information is missing when something rejects or pends. If your process includes sending supporting documents, they may need access to wherever you store and label attachments, plus the ability to send them when requested.
For eligibility and coverage checks, they need the screens or sections used to check whether a policy is active and what benefits apply. They may also need access to the parts of the patient record where insurance details are stored, so they can confirm what is on file matches what the payer has. If your policy is that only the practice updates insurance details, state that clearly and keep it that way.
For patient balance follow up, they need access to billing notes, statements or communication history (whatever you use), and the ledger view that shows what is outstanding and why. They also need a clear place to document what they did, so your front desk is not guessing after the fact. If you do not want an outsourced team to take payments, say so upfront. Not every practice is comfortable with that.
Appoint a single practice admin contact to manage access. One person should approve permissions, request new accounts, reset credentials, and answer day-to-day “where do I find this?” questions. It stops mixed messages and avoids staff sharing logins to get around delays.
Keep the security basics under your control. Use unique logins for each outsourced team member, not shared accounts. Set role-based access, meaning access is tied to a job role like “billing follow up” rather than full admin rights. If someone changes role or leaves, you can revoke access quickly without disrupting anyone else.
One small judgement call that saves trouble: start tighter than you think you need, then expand access only when a real task is blocked. It is easier to grant an extra permission than to unwind access that was too broad.
Get your payer and plan information in one place
Insurance billing drags when the rules live in five different places and nobody is sure which version is current.
You do not need a perfect payer manual. You do need one agreed place where the outsourced team can look first, so they are not stopping to ask the same questions on every claim.
Start with a simple “top payers” list. Include the payers you bill most often, plus any payer-specific rules your practice relies on. Keep it practical, not theoretical. For example: which payers need a particular claim format, which ones tend to require extra documentation for certain procedures, and any recurring denial reasons you see from them that have a known fix in your practice.
Add your preferences for attachments, narratives, and claim notes. Attachments are the supporting documents a payer asks for. A narrative is the short explanation that goes with a claim when the standard codes do not tell the whole story. Claim notes are the internal notes you keep for follow up. Decide what “good” looks like in your practice, including who writes narratives, what you include, and where you store attachments so they can be found later. If your rule is “only send what the payer requests”, write that down too.
Be clear on how you handle secondary insurance and coordination of benefits. Coordination of benefits (COB) is the process of deciding which plan pays first and how the second plan considers what is left. Note your usual workflow: what has to be on file before a secondary claim is sent, what you do when the primary payer response is needed first, and who in the practice confirms the patient’s plan order when it is unclear.
Also document where EOBs and remittance details are stored, and who posts them. An EOB is an explanation of benefits, meaning the payer’s breakdown of what they allowed, paid, or denied. Remittance details are the payment and adjustment lines that support what hits the ledger. If your practice posts payments in-house, say so and state what the outsourced team should do instead, such as flagging items that need posting or reconciling. If the outsourced team is expected to post, spell out the boundary and the checks you want.
One small judgement call that helps: capture your “house rules” as decisions, not essays. A short note like “Payer X: attach documentation for repeat denials on Y” beats a long document nobody keeps updated. If you are not sure about a rule, label it as “unconfirmed” so nobody treats it as fact.
Define your financial policies and patient communication rules
Patient balance follow-up works best when the outsourced team knows your rules, your voice, and where the line is.
Outsourced patient billing support is still your practice speaking to your patients. If your policies are unclear, the team ends up either being too soft to be helpful or too firm for your brand. Neither feels good on the patient side, and it creates extra work for your front desk.
Start with your payment expectations at the time of service. Be specific. Do you collect the full patient portion on the day, a deposit, or only after insurance has processed? Then define when balances are billed. For example, after the insurance payment posts, after a statement goes out, or after a set number of days. If your process differs for planned treatment versus emergency visits, write that down too.
Next, set the boundaries for disputes, refunds, credits, and small balances. The practice sets policy here, not the outsourced team. Spell out what counts as a dispute, who can make adjustments, and what information you want gathered before it comes back to you. A credit is a positive balance on the patient account, often from an overpayment or an insurance reprocessing. A refund is money you return to the patient, and it usually needs an approval step in your practice. For small balances, decide whether you write them off, bill them, or roll them into the next visit, and how that choice is made.
Give tone and script guidance for patient balance follow-up. You do not need a full call centre script. You do need a few approved phrases and a clear order of operations. For example: confirm the patient identity, reference the statement date, explain the balance in plain language, offer the payment options you accept, and agree the next step. Also note words you do not want used. If your practice avoids pressure, say so. If you prefer direct but polite, say that too.
Build in a simple escalation path for sensitive calls. This includes hardship situations, complaints, repeated disputes, threats to leave the practice, or anything involving clinical dissatisfaction. The outsourced team should know when to pause and hand it back to a named person in the practice, and what notes to capture so the patient does not have to repeat themselves.
Be clear about payment methods. List what patients can use, such as card, bank transfer, cheque, or payment at the practice. Then tell the outsourced team exactly what to say. For example, “We can take payment by card over the phone” or “If you prefer, you can pay at reception during your next visit.” If there are methods you do not accept, state that plainly so the team does not improvise.
One small judgement call that saves friction: choose consistency over creativity. A short, approved set of phrases and a tight escalation rule will feel more professional to patients than staff making it up call by call, even when everyone is trying to be helpful.
Set up a clean handoff for posting and follow up
Most billing mess shows up in the gaps between posting, payments, and the next chase. Write down who does what, and how the other side finds out.
Before you outsource, decide who posts payments and adjustments in your system. Posting means recording money received and applying it to the right account. Adjustments are changes to the balance that are not a payment, such as a contractual write-off or a correction.
Some practices want their in-house team to post all insurance payments and adjustments because it ties into banking, end-of-day checks, and cash control. Others are comfortable with the outsourced team posting insurance payments and contractual adjustments while the practice handles patient payments. Either can work. What does not work is both sides posting the same items or neither side knowing what has been posted.
If your practice posts payments, agree how the outsourced team is notified that a claim has moved. That can be as simple as a daily message that lists what was posted and what needs follow up, or a shared queue you update when the remittance has been entered. The key is that the outsourced team can see the change without guessing or re-checking every claim.
Denials need a routing rule. A denial is when the payer says they will not pay as billed, or they need more information before they will pay. Split denials into two buckets: missing or unclear clinical documentation, and billing corrections.
Missing clinical documentation should route back to the practice. The outsourced team can request the needed item and tell you exactly what the payer asked for, but they should not be changing clinical notes. Decide who in the practice gathers clinical narratives, perio charting, x-rays, referral details, or signed forms, and how those are provided back for submission.
Billing corrections can usually stay with the outsourced team. This includes fixing member details, dates, claim format issues, coordination of benefits errors, missing modifiers, or a resubmission with corrected information. Be clear on what the outsourced team is allowed to change on a claim, and what requires your approval.
Agree on a single definition of “next action” for every claim. Next action means the one step that will move the claim forward, not a general status like “in progress”. Keep the options tight so reporting stays meaningful.
Typical next actions look like: wait (with a date to recheck), call payer, request information from the practice, request information from the patient, correct and resubmit, appeal, or post and close. If you use “wait”, require a reason and a follow-up date. Otherwise claims can sit in limbo with no ownership.
For patient balances, decide how notes are documented so the story carries across calls. Ask for notes that capture the who, what, and next step: who was contacted (or not reached), what was discussed in plain language, what was agreed, and when the next follow up should happen. Include how payment was taken or offered, and any constraints like “patient asked to call back after payday”. Avoid vague notes like “left message” without context.
One small judgement call that prevents rework: pick one owner for “closing the loop”. That means one side is responsible for confirming the payment or correction was posted, and then marking the claim or patient balance as completed with a final note. When both sides assume the other will close it, you get duplicate chasing or missed follow ups.
Plan communication: cadence, channels, and escalation
Predictable communication stops small questions turning into delays.
Outsourced billing only stays tidy when day-to-day questions have a clear home. Owners and managers usually want the same thing here: fewer surprises and faster decisions. You get that by naming contacts, picking channels, and agreeing what counts as urgent.
Start by naming a primary and a backup contact at the practice. Primary is who the billing team should go to first for answers and approvals. Backup is who steps in when the primary is off, in surgery, or just buried. If you do not assign a backup, questions either stall or get sprayed around the practice until someone replies.
Then set the channel rules. The exact setup varies by practice and by what you are comfortable with, but the principle is consistent: one route for routine work, a different route for urgent issues.
Routine questions are things like “Is this patient’s address updated?” or “Can you confirm the correct subscriber details?” These can usually go through a single agreed channel where they are easy to track and answer in batches. Urgent issues are the ones that can change the patient experience today, or put money at risk if you miss a deadline.
One short definition helps: escalation means the issue has a deadline, a patient impact, or it is blocked until the practice responds. If it is an escalation, it should not sit in the same queue as routine questions.
Plan for a regular check-in during the early period. Weekly is often enough to keep things moving without turning it into a meeting-heavy exercise. Use it to review what is stuck, what decisions are needed from the practice, and whether the workflow rules you agreed are working in real life. Once the process settles, adjust the cadence as needed rather than keeping the same schedule out of habit.
Be specific about escalation examples, so nobody has to guess.
Claim stuck due to missing information: if a claim cannot move because something is missing, it should escalate with one clear ask. For example, “payer needs the date the appliance was seated” or “missing referral details”. “Claim stuck” is not enough. The message should say what is needed, who should provide it, and when it is due.
Patient complaint: if a patient calls upset about a statement, a balance, or a collection-style message, it should escalate quickly to the practice contact. Even if the outsourced team handles patient billing support, you will want visibility and a decision on tone, next step, and any exceptions. This is also where the practice may need to check the clinical context, like whether treatment changed.
Payer request for records: payers sometimes ask for records to process a claim. Records means clinical documentation like narratives, images, charting, or signed forms. The outsourced team can relay exactly what was requested and where it should be sent, but the practice must provide the records. Set an escalation route for this, because it is often time-sensitive.
One small judgement call that helps: keep escalations rare by design. If everything is labelled urgent, nothing is. Agree that escalations must include a deadline or a clear patient impact, and require the message to contain a single, specific question to answer. That keeps your day moving and stops long back-and-forth threads.
Gather the minimum documents and examples for onboarding
Send a small, real-world pack so billing can start with fewer guesses and fewer back-and-forth questions.
Onboarding goes faster when the outsourced team can see how your claims and patient balances look in the real world. Not perfect examples. Normal ones. A short pack of documents and a few common scenarios is usually enough to start working accurately.
Keep it de-identified where you can. That means remove names, dates of birth, addresses, policy numbers, and anything else that ties back to an identifiable person. If you are not sure what to remove, ask first rather than sending full patient details by habit.
Start with a handful of recent EOBs and denial letters. An EOB is an Explanation of Benefits from the payer that shows what they paid, what they denied, and why. Denial letters (or portal denial messages) are useful because they show the payer’s wording and the reason codes you are actually seeing.
Include examples that reflect your common claim scenarios, especially the ones that tend to trip you up. For example: a claim that paid as expected, one that denied for missing information, one that downgraded or reduced, and one that needed a correction or resubmission. If you can, add one example per main payer type you deal with most.
If you use fee schedules or reference points to check claim accuracy, share what you have available. Some practices have payer fee schedules to hand, some do not, and some only have internal reference points. Availability varies and that is normal. What matters is the outsourced team knows what you want used as the reference when checking charges and payments.
Next, gather any templates you already use. That can include patient statements, standard email or letter wording for balance follow-up, and any recare call notes or scripts your team works from. If you do not have templates, say so. The outsourced team can still work, but they need to know your preferences on tone, timing, and what should never be said to patients.
It also helps to provide a simple list of common procedure types you bill and any recurring billing patterns that affect claims. This is not clinical guidance. It is the admin pattern that changes what gets submitted and followed up. For instance, if you often split treatment across visits, if certain procedures regularly need supporting information from the practice, or if you see repeat issues with eligibility and coverage checks before treatment.
If there are payer-specific habits you have learned the hard way, include those too, but keep them factual. “Payer X often asks for extra information” is useful. “Payer X always pays in 7 days” is not something to assume or rely on.
One small judgement call: send fewer, better examples rather than a whole folder dump. Ten to fifteen well-chosen items usually teach more than a hundred mixed documents. If the team needs more, they will ask with a clear reason.
Agree on boundaries, approvals, and accountability
Reduce risk by deciding what the outsourced team can handle day to day, and what must be checked by your practice first.
Outsourced billing works best when everyone knows the line between “just do it” and “pause and ask”. Without that, small tasks stall and bigger decisions get made without the right context. This is not about control. It is about protecting the practice, the patient relationship, and your numbers.
Start by listing the routine actions your outsourced team can take without approval. This is usually the repeatable follow-up work, like checking claim status, responding to payer requests for missing details, and re-submitting a claim when the correction is straightforward and supported by your notes. Claim follow-up means contacting the payer to get a claim processed, paid, or properly denied.
Then define what needs sign-off. Good examples are anything that changes money or patient-facing outcomes in a material way, such as large balance adjustments, write-offs outside your normal policy, refunds, and handling patient disputes about what they owe. If a patient is unhappy or confused, the tone and the decision matter, so it should not be left to assumptions.
Also agree on boundaries around insurance verification and recare calls. Eligibility checks can be done without approval if you have a standard checklist. But decisions based on that information, like whether to proceed or change a financial plan, belong with the practice. Recare calls can follow your preferred wording and timing, but anything that crosses into clinical advice or treatment decisions should be routed back to your team.
Corrections are where scope gets tested. Decide upfront what happens when information is missing, inconsistent, or unclear. A common approach is: the outsourced team flags the issue, explains what is conflicting, and asks a focused question. The practice then supplies the missing detail or confirms the correct information. If the record itself needs changing, your practice makes that change, because it is your system and your patient record.
Be specific about what counts as “inconsistent”. For example, a payer denial that says the member ID does not match, a claim that does not align with the coverage checked, or a patient balance that does not tie to an EOB. An EOB is the payer’s Explanation of Benefits showing what they paid and why.
Set a simple responsibility split and put it in writing. The practice owns clinical decisions and patient care, including treatment planning, clinical notes, and anything that could be interpreted as dental advice. The outsourced team owns billing follow-up within the agreed scope, including claim submission and follow-up, patient balance follow-up, insurance verification tasks, and recare calls based on your direction.
One small judgement call that helps: pick a clear threshold for approvals. It can be a money amount, a situation type, or both. The exact number is your choice. What matters is that everyone can recognise when to stop and ask, without debating it each time.
FAQ
Words from the experts
When a practice is getting ready to outsource dental billing, we often see the same snag repeat: access exists, but it is incomplete or unclear, so work pauses while someone tracks down what is missing. One simple habit helps early on – keep a single shared handoff document that lists who to contact for each question (insurance, patient balances, verification, recare), and who can approve decisions when something is not straightforward.
If you only do one thing before you hand billing off, make your escalation rules explicit and stick to them. It is a calm way to protect patients and your team: anything that becomes a complaint, a dispute, or sounds clinical gets routed back to the practice for a decision, while routine claim follow-up, eligibility checks, and balance calls can keep moving.