MedicaidAdministrativeMedium impact
HIPAA changes to the Eligibility Verification System response
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Oct 10, 2003
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid is implementing HIPAA-compliant changes to their Eligibility Verification System (EVS) for providers using commercial verification vendors. Medical status codes will be removed and replaced with eligibility descriptions, recipient addresses will be added, and commercial insurance policyholder names/SSNs will no longer be provided.
Action Required
Before October 10, 2003: Billing teams using commercial eligibility verification vendors must update workflows to interpret new eligibility descriptions instead of medical status codes. Contact your commercial verification vendor to understand system changes for processing Wisconsin Medicaid eligibility responses. Note that AVR system and Provider Services are not affected by these changes.