As a dentist looking to acquire a fee-for-service (FFS) practice, you may come across a unique opportunity: a practice where the selling doctor is completely out-of-network with all dental insurance plans. These practices often focus on delivering high-quality, personalized care while avoiding the restrictions and reduced reimbursements associated with insurance participation. But once you take over, a common question arises:

Do you need to register as an out-of-network provider with dental plans to submit claims and receive payment?

The Short Answer:

In most cases, no — you do not need to formally register with insurance companies to submit claims as an out-of-network provider. However, there are some nuances worth understanding to ensure a smooth transition and to set the right expectations for reimbursement and patient communication.

What It Means to Be Out-of-Network

An out-of-network dentist is simply one who has not signed a participating provider agreement with a dental insurance plan. This means you are not bound by the insurer’s fee schedule, administrative rules, or restrictions.

In an out-of-network FFS practice:

• Patients pay you directly for your services.

• You or your team may still submit claims on behalf of patients to their insurance companies.

• Reimbursement is typically sent directly to the patient, unless you've arranged for assignment of benefits (AOB).

Submitting Claims as an Out-of-Network Provider

Even without being registered with insurance plans, you can (and should) submit claims on behalf of your patients. This helps maximize their benefits and simplifies their experience — a key to retaining patients after a practice transition.

Most insurance companies allow any licensed dentist to submit claims, whether in- or out-of-network. However, they will require:

• Your Tax ID number (TIN)

• Your National Provider Identifier (NPI)

• Your licensure and practice location information

This information is typically provided via a W-9 form and/or a claim submission registration — not a contract. This allows the insurer to process claims and track payments without entering into a participating provider agreement.

When Might You Need to Register?

Some insurance companies may require basic enrollment or a provider setup to process your claims even as an out-of-network provider. This is not the same as credentialing or contracting — it’s often just to get you into their system so they can send payments and verify your legitimacy.

In some cases, registering with payers may:

• Enable assignment of benefits, so you can receive payments directly instead of the patient.

• Prevent claim rejections or delays due to missing provider setup.

• Simplify electronic claims processing through clearinghouses.

Contact major payers and ask if they require any “non-participating provider registration” for out-of-network claims.

Key Considerations When Taking Over a FFS Practice

1. Continue the Current Model Initially
   Patients in a successful FFS practice are likely accustomed to paying upfront and receiving reimbursement directly. Maintain this workflow until you fully understand the patient base and payer mix.

2. Verify Assignment of Benefits Policies
   If the previous doctor received payments directly from insurance as an out-of-network provider, clarify what arrangements were made with insurers. Some companies allow this with proper documentation.

3. Educate Your Team and Patients
   Ensure your front desk and billing team understand how to handle out-of-network claims, collect payments, and help patients get reimbursed. Provide clear communication to patients about what to expect.

4. Evaluate Your Long-Term Strategy
   You may decide later to join selected plans based on patient demand or competitive pressures. But buying an FFS practice offers the rare chance to build your practice around independence from insurance.

Final Thoughts

Buying a fee-for-service, out-of-network practice offers a pathway to greater clinical freedom, personalized care, and potentially higher profitability. You do not need to register as a contracted provider with insurance companies to maintain this model — but you may need to provide your credentials for claims processing purposes.

Careful planning, patient education, and open communication with insurance companies will help you maintain the integrity of the FFS model while ensuring timely reimbursements and patient satisfaction.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com