Here’s how to verify benefits for outpatient facility services

Benefits for outpatient facility services that need a Current Procedural Terminology or Health Care Procedure Coding System procedure code are based only on the reported procedure code, and not the related revenue code.

Please remember that when a procedure code can’t be paid based on the group’s benefits, the payment will be rejected and become the member’s responsibility.

To check a member’s benefits, based on the HCPCS code, for Michigan Operating Systems migrated groups:

• Log in to web-DENIS.
• Click on Subscriber Info.
• Click on Benefit Search.
• Click on the Benefit Package Report tab.
• Enter the Benefit Package information.
• Enter the HCPCS code under Topic and click on Finish.
• Click on Search.

The results are displayed in the Benefit Package Report tab under Coverage Status, and are not a guarantee of payment.

Member benefits for non-migrated National Accounts Service Company groups are available only on web-DENIS, and are based on the benefit category. To check a member’s benefits:

• Log in to web-DENIS
• Click on Subscriber Info
• Click on Eligibility/Coverage/Coordination Of Benefits
• Enter the contract number
• Click on Enter
• Under Current Coverage Member Information, click on Detailed Benefits, then on HOSP
• Click on Hospital Outpatient provider type and click on Go.
• Review benefits.

Facility payment rules will still be available under the HCPCS Payment Rule Display tab under Facility Claims on web-DENIS. If you have any questions about how to view this information, please contact your provider consultant.