Dental billing best practices for two-step procedures

May 2023
Tiffany Wesley, FAADOM
Admin/Record Keeping/Charting

Dental billing best practices for two-step procedures

Are you seeing dental claim denials for two-step procedures, such as crowns and removable prosthodontics? You aren’t alone. We asked one of the Practice Booster Advisors to give dental billing best practices for two-step procedures so that you can confidently avoid unnecessary denials.


Incurred liability date

When you are sending a dental claim for a two-step procedure, when should you send it? All dental plans have incurred liability dates. An incurred liability date is when the payer is liable to consider a benefit, as defined by the dental plan document (e.g., prep date or seat date of a crown). When verifying the patient’s dental insurance benefits, it is best practice to ask for the plan’s incurred liability date. This is crucial information to avoid an unnecessary claim denial or negative impact on a patient’s yearly dental benefits.


If your dentist is in-network with the patient’s insurance carrier, then most likely the PPO contract states no services are to be submitted until they are complete. If your dentist is out of network with the patient’s insurance carrier, it is advisable to still be mindful of the incurred liability date of the plan when submitting the dental claim. A majority of dental benefit plans have incurred liability dates of seat/delivery.

When should you send the dental claim?

When a plan or PPO contract has an incurred liability date of seat date for a crown, for example, submit the buildup date reflecting the date of service as the completion date of the buildup then submit the crown reflecting the date of service as the completion date (seat date) of the crown. Many plans, such as most Cigna plans, will be more likely to consider benefits for the buildup with this dental billing process.


It is recommended that the crown and buildup be charged to the patient’s ledger at the prep date. This allows for the patient’s estimated portion to be collected at that date of service. Whether the dental claim is also submitted on that date will be based on the incurred liability date of the plan.


Some insurance payors are now requiring that the date of service in Box 24 of the 2019 ADA Dental Claim form reflect the seat date when the plan has an incurred liability date of seat date. Some insurance benefit plans still allow the prep date to be reflected in Box 24, with a note in the Remarks Section stating the seat date. It is recommended to err on the side of caution as many insurance carriers are scanning and reading dental claims with computers, so the information captured for adjudication would be the date of service in Box 24, not the comments in the Remarks Section.


This can be challenging for many dental offices that want to see accurate monthly gross production numbers. If you are unsure, reach out to your software support team to see if and/or how the procedure can be billed to the patient ledger on the prep date (aka first step), but reflect the seat or delivery date (aka second step) when completing the dental billing processes within your specific practice management software. 

Become an advanced dental billing specialist

Want to learn more dental billing and administration best practices? Dental Administration with Confidence dives deeper into this subject, along with many others. This guide is filled with proven solutions for both common and complex problems facing every practice today. Dental Administration With Confidence is easy to understand and packed full of information, tools, and solutions to help your team maximize reimbursement, reduce claim denials and delays, increase patient satisfaction, and boost revenue. Plus, it is perfect for both new and experienced team members. 


Grab yours today! You can also save 11% when you bundle it with Dental Coding with Confidence.


And did we mention that our resources are available as ebooks? CLICK HERE!


We also highly recommend Dental Zing’s Advanced Dental Billing on-demand CE course series.



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Fixed Partial Denture Repair

A single cast metal crown restoration that is retained, supported and stablized by an abutment on an implant; may be screw retained or cemented.

NOTE: May be orthodontic related