MedicaidAdministrativeLow impact
Revised form for reporting discrepancies in recipients' other health care coverage information
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Feb 1, 2004
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid has revised the Other Coverage Discrepancy Report form (HCF 1159, dated 02/04) to allow for more complete information when reporting discrepancies in recipients' other health care coverage. Providers should discontinue using old versions and begin using the new form immediately.
Action Required
Immediately: Stop using old versions of the Other Coverage Discrepancy Report form. Begin using revised form HCF 1159 (dated 02/04) for all discrepancy reports. Download the fillable PDF from the Wisconsin Medicaid website or call Provider Services at (800) 947-9627 to request paper copies. Ensure staff attach photocopies of insurance cards and documentation when submitting reports.