MedicaidAdministrativeLow impact
Revised form for indicating discrepancies in recipients' other health care coverage information
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Oct 1, 2002
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid has revised the Other Coverage Discrepancy Report form (HCF 1159) to make it clearer and easier to complete. Providers should discontinue using old versions and begin using the new form dated 10/02 to report discrepancies in recipients' other health care coverage information.
Action Required
Immediately: Wisconsin Medicaid providers must stop using old versions of the Other Coverage Discrepancy Report form and begin using the new form HCF 1159 dated 10/02. Download the fillable PDF from the Wisconsin Medicaid website at www.dhfs.state.wi.us/medicaid/ under Provider Forms, or request paper copies by calling Provider Services at (800) 947-9627. Use this form to notify Wisconsin Medicaid of any discrepancies between coverage information in the Eligibility Verification System and information from other sources.