Who Owns What? Building the Handoffs That Make Centralized RCM Work

A patient arrives with a new insurance plan that does not exist in the practice-management system. The doctor identifies treatment that could be started today, or we have an opening first thing tomorrow at 8:00 am. But before the patient can make a financial decision, the team needs an accurate insurance estimate.

If the handoff is slow or unclear, the practice may lose a same-day treatment opportunity, leave productive chair time unused or frustrate the doctor with wasted clinical time. 

The office appropriately does not have permission to create insurance plans. That responsibility has been centralized with a trained insurance specialist.

But now the team has a different set of questions:

• How does the office request the plan?
• What information does the insurance specialist need?
• How quickly will someone respond?
• Who is the backup if the insurance specialist is unavailable?
• How does the office know when the plan and estimate are ready?

Centralizing plan creation is a best practice to keep an accurate insurance database and maintain accurate insurance estimates. The challenge lies when we need a fast turnaround, and we haven’t designed the handoff.

Every centralized RCM workflow needs six things: an owner, required information, a system of record, a deadline, backup coverage and a clear definition of complete.

Choose the model that fits your organization

There is no single perfect centralized RCM model.

Some dental groups centralize only their most specialized insurance responsibilities: fee-schedule management, insurance-plan creation, payment posting and outstanding insurance follow-up. The practices continue to manage eligibility, claim preparation, attachments, patient collections and other daily revenue-cycle tasks.

Other groups add patient-balance follow-up to the centralized team because the practices are not consistently calling patients or collecting outstanding balances.

A third group may centralize claim attachments and additional claim-preparation work. This may be appropriate when the central team has stronger documentation and coding expertise or when inconsistent attachments are delaying claims.

The right division of labor depends on the training and accuracy of both the practice and centralized teams, the resources available, current collection and insurance-AR performance, and the organization’s operating philosophy.

The model can also evolve. During a software conversion, the centralized team may temporarily assume more responsibility while practices learn the new system. As office competency improves, some work may move back to the practices. In other organizations, centralization may expand because the specialized team is producing more accurate and timely results.

The goal is to place each responsibility with the team most capable of completing it accurately and on time.

Build the “Who Owns What” map

Saying that the practice and RCM “share responsibility” is not enough. Shared responsibility must be divided into specific obligations.

A common model may look like this:

The exact assignment will vary. For example, Dentrix Ascend provides attachment alerts and a relatively quick process for adding claim attachments. A group may keep this responsibility at the practice so missing attachments and immediate claim rejections can be resolved quickly. Another organization may assign attachments to a centralized claims team with stronger coding and documentation knowledge.

A “Who Owns What” guide should sit above the organization’s custom SOPs and show how the full revenue cycle fits together. The individual SOPs can then explain exactly how each task is completed in the software.

The ownership guide should also identify what changes during staff turnover, vacations, software conversions or other periods when the normal operating model is temporarily disrupted.

Define the handoff from request through completion

For smaller teams, as much patient-specific information as possible should remain inside the PMS.

Consider the insurance-plan request. The digital form captures the insurance card image and the team manually enters the required information into a standard patient note (using a template for consistency). The office sends the central team the chart ID and urgency, allowing the insurance specialist to review the details in the patient record.

This keeps the PMS as the primary source of truth rather than creating a second patient record through email or Microsoft Teams.

The organization must also define what “complete” means. An insurance-plan request is not complete simply because a plan now exists in the software.

Completion may mean:

• The plan follows the approved naming convention.
• The correct fee schedule and coverage table are attached.
• In-network status is correct.
• The patient and subscriber are connected to the plan.
• Eligibility has been rerun.
• The estimate has been refreshed.
• The office has been notified that it can proceed.

The service standard should distinguish between acknowledgment and resolution. A centralized team may quickly acknowledge that a request has been received, but the office also needs to know when the work will be completed.

An emergency-escalation path is equally important. The normal turnaround may work for a patient scheduled three days from now, but it will not solve the 4 p.m. patient who needs an estimate before tomorrow morning.

Use Teams until Teams becomes the problem

For a smaller group, a Microsoft Teams channel may work beautifully. It is flexible, easy to access and can support collaboration while the organization expands training to additional office managers.

To keep Teams manageable:

• Use a standard request template.
• Reference the chart ID rather than repeating unnecessary patient information.
• Direct the insurance specialist to the patient note for insurance details.
• Assign a primary and backup owner.
• Clearly mark the request when it is complete.

As the organization grows, one channel may become overwhelming. A practical interim step is to create a channel for every two or three offices and assign a primary and backup insurance specialist to each group.

When requests are being missed, offices cannot determine status or leadership cannot report on volume and turnaround, it is time for a structured ticketing system.

A ticketing system can require the office to provide the insurance card, chart ID, request category, appointment date, deadline and other information before the ticket can be submitted. Dropdowns make requests easier to document and route, while automatic assignment and status tracking create visibility for both teams.

Larger groups may use the same support environment for RCM, credentialing and provider requests. But ticketing systems can also be abused by busy offices that submit a ticket instead of completing the investigation or action they still own. Quarterly reporting should identify which locations and users generate the highest ticket volume. A little targeted training may eliminate a substantial amount of unnecessary work.

Set response standards—and staff the team to meet them

Each centralized responsibility needs a service-level expectation based on its urgency.

Emergency plan creation may require completion within one hour. That expedited pathway supports more than unusual end-of-day emergencies. It also protects same-day treatment opportunities when a patient arrives with new coverage or when the doctor diagnoses treatment that can be completed while the patient is already in the practice. 

Routine requests may be completed within one business day. If automated eligibility runs four days before the appointment and the office reviews the results two or three days out, most plan requests should reach the central team before they become emergencies.

Payment posting needs a consistent cadence. At minimum, all payments must be posted before the applicable provider-payroll deadline. Unapplied credits should also be reviewed monthly so doctors receive credit for all recognized revenue.

Outstanding insurance claims are less urgent at the individual transaction level, but consistent follow-up is essential to protect timely filing and keep cash moving.  The 2025 Catalyst Index from Henry Schein One found an average of 18 days from claim submission to payment or claim closure. Top-performing practices averaged seven days. Reaching that level requires more than assigning claim follow-up to a central team. It requires clear ownership, consistent effort and enough capacity to complete the work.

The RCM leader is responsible for monitoring request volume, backlog, turnaround and missed service levels. If demand exceeds the team’s capacity, the leader must expand or cross-train the team. Think of this as “belt and suspenders.” The belt is the training and SOP that explains how every transaction should be handled. The suspenders are the reports that confirm whether the work is actually being completed accurately and on time. 

Align software rights, passwords and MFA with ownership

The PMS permission structure should follow the work ownership map.

Fee-schedule access should be the most restricted. Insurance-plan creation and in-network contract settings should be limited to trained insurance specialists. Regional managers are often best to update in-network settings so they can support practices quickly. Office teams generally need the ability to connect patients and subscribers to existing plans without receiving access to global insurance configuration.

Many software rights are tied together, or permission to complete one task may provide access to an entire screen containing other sensitive information. Ask your software vendor to explain exactly what each permission allows.

The same discipline applies to payer portals. Eligibility and insurance follow-up often require portal logins, password updates and MFA access across multiple locations and teams. Explore using an approved password-management solution, establish secure backup access and avoid informal credential sharing. Access should be removed immediately when an employee leaves, and the organization should review administrative and other high-risk permissions quarterly.

Keep the practice as the patient-facing front door

Centralization should simplify the patient experience, not expose patients to the organization’s internal handoffs.

The practice remains responsible for welcoming the patient, capturing accurate insurance information and maintaining the patient’s current cell phone number, email and mailing address. That information supports eligibility before the visit and patient collections afterward.

When a patient has a billing question, the office should remain the front door. The practice answers what it can from the ledger, sends a complete request to RCM when specialized help is needed and follows up with the patient after receiving the answer.  Text messaging makes this closed-loop communication much easier. The office can acknowledge the question, obtain the correct information from RCM and update the patient without making the patient locate the right person in the billing department.

A handoff is not complete when it is sent

Let’s return to the patient who arrives with a new insurance plan. The practice may have an opportunity to complete treatment that same day—or an opening at 8 a.m. tomorrow. Either way, the team needs an accurate estimate before the opportunity disappears.

The office does not need permission to create the plan itself. It needs a reliable way to reach the trained insurance specialist, provide complete information, communicate the urgency and know when the plan and estimate are ready. 

This is the real measure of a successful centralized model: the work is assigned to the right insurance specialist without slowing down the practice or the patient. Everyone knows what they own, what information must be provided, when the work is due and what complete looks like.

Start with one high-volume RCM workflow and map it from beginning to end. Then put the “belt and suspenders” in place: train each team on its responsibility and run the report that confirms the handoffs are working.

When the model works, the practice can confidently move treatment forward, the centralized team can focus on the specialized work it does best, and leadership gains the visibility needed to expand or adjust the model over time.