Positive Pay for Medical, Dental, and Healthcare Practices
Medical, dental, and healthcare practices write a steady stream of paper checks: to laboratories, imaging centers, dental supply and equipment vendors, billing services, pharmaceutical distributors, landlords, payroll, and refunds to patients and insurers. Many of these are recurring relationships with predictable timing and amounts, which is exactly what makes them a target. A criminal who intercepts one check, or who tricks the office into changing a vendor's payment details, can move money before anyone reconciles the account.
Positive pay is a bank service that checks every item presented against a list you upload. If a check's number, amount, or payee does not match what you issued, the bank flags it for your review before it clears. This page explains why the service fits this sector and how to produce the file the bank needs.
Why check fraud hits medical and dental practices
Checks remain the payment type most often targeted by fraud. In the 2025 AFP Payments Fraud and Control Survey, which covers 2024 activity, 79% of organizations reported attempted or actual payments fraud, and 63% experienced check fraud, the highest of any payment method. Despite that, most organizations say they have no plans to reduce check use.
Practices in this sector carry a few specific risks:
- Many vendor relationships. Labs, supply distributors, equipment leases, software subscriptions, and contract services mean dozens of recurring payees. Each one is a relationship a criminal can impersonate.
- Vendor and business email compromise. A scammer poses as a supplier or staff member and requests a change to bank details or a check sent to a new address. The FBI's Internet Crime Complaint Center continues to rank business email compromise among the costliest fraud categories.
- Front-desk and back-office separation. Clinical staff are focused on patients, so finance tasks are often handled by one person or outsourced, which can weaken the second set of eyes that catches an altered check.
- Patient and insurer refunds. Refund checks add volume and unfamiliar one-time payees, which are harder to verify by memory alone.
How positive pay and payee positive pay protect you
Standard positive pay matches the check number, amount, and account on each presented item against your issued list. If someone alters the amount on a stolen check, or prints a counterfeit check on your account, the mismatch becomes an exception you can return.
Payee positive pay adds the payee name to the match. This is the version that matters most for fraud where a criminal washes a real check and rewrites the payee, or prints a check that copies your number and amount but names a different recipient. For a practice that pays many similar vendors, payee matching closes a gap that number-and-amount matching alone leaves open. You can read more in our guide to payee positive pay and the overview of how positive pay stops check fraud.
It helps to understand the trade-offs against the simpler model in positive pay vs reverse positive pay, where the bank pays by default and you review after the fact.
Producing the check-issue file from your practice software
Positive pay depends on a check issue file: a list of every check you wrote, sent to the bank before those checks reach it. Most practices generate checks from accounting software (QuickBooks is common) or from a practice management system such as Dentrix, Eaglesoft, or an EHR with a payables module. The workflow is usually:
- Print or record the day's checks in your software.
- Export a register or report that lists check number, date, amount, and payee.
- Convert that export into the exact layout your bank requires.
- Upload the file to your bank before its cutoff time, and include voided checks so they cannot be presented later. See how to handle void checks.
If you use QuickBooks, our step-by-step guides cover QuickBooks Online and QuickBooks Desktop. You can paste or upload your register into the free generator and map your columns to the bank's format.
Every bank's file layout is different
There is no single national standard. Some banks want a fixed-width text file with specific column positions; others want CSV. Field order, date format, and how the amount is written all vary by bank. Many banks expect amounts with an implied decimal, where $125.00 is written as 12500 with no decimal point. The difference between layouts is explained in fixed-width vs CSV.
We do not publish exact byte positions for individual banks because they are account-specific and change. Use the layout your bank gives you in writing, then build it with the free custom format builder. Our positive pay file format reference and glossary explain each field.
Verify your first file before you rely on it
Before you trust the service, confirm that one real file is accepted and matches cleanly. A few checks:
- Run your file through the file validator to catch format problems early.
- Confirm the bank accepted it without an error and that your check count and total match your register. If it bounces, see why files get rejected.
- Watch the first cycle for exceptions caused by formatting, such as a payee name that does not match because of how your software abbreviates it.
If you are still deciding, our notes on whether you need positive pay and the cost of positive pay can help, along with the broader check fraud statistics page. For the source figures cited above, see the AFP 2025 Payments Fraud and Control Survey announcement.