MedicaidAdministrativeLow impact
Update to the Consent to Sterilization Form Submission (Federal Form OMB No. 0937-0166), Hysterectomy Information Form (W-613) and Physician Hysterectomy Certification Form Retroactive Eligibility (W-613A)Submission Process
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN, Urology, General Surgery·Provider Bulletin
We identified it
Jun 20, 2026
Summary
DXC Technology has updated the submission process for sterilization and hysterectomy forms. Providers can now fax these forms to 1-860-986-7995 and must use a new mailing address: DXC Technology, PO Box 2971, Hartford, CT 06104.
Action Required
Immediately: Update office procedures to use new fax number (1-860-986-7995) and mailing address (DXC Technology, PO Box 2971, Hartford, CT 06104) for submitting Consent to Sterilization Forms (OMB No. 0937-0166), Hysterectomy Information Forms (W-613), and Physician Hysterectomy Certification Forms (W-613A). Staff should update contact lists and filing procedures.