Technical Interface Guidelines

Health Plan Interface

Third Party Liability (TPL) Process

Introduction

The Third Party Liability (TPL) process identifies:

Verified TPL data received from and updated by our TPL contractor
Invalid TPL notifications

TPL referral data is received from many different sources including Health Plans, eligibility sources (DES, SSA, etc) and our TPL contractor. The referrals are processed through a validation process and we receive updates to the referrals that either verify TPL data or invalidate referrals. In addition to the TPL verifications, Medicare data is also provided on the file.

Schedules

The following table outlines schedules for the Third Party Liability process.

Processing requirement	Schedule
The TPL file processing	is performed seven days a week for each Health Plan under contract with AHCCCS. This file is produced near the end of the daily batch update cycle.
The Medicare data update process	is performed on several different schedules including daily, semi-monthly, and monthly.
TPL Daily Verified data files	contain verified TPL data that are downloaded to the AHCCCS Communications Server, verified, and available for extraction by the Health Plan by 7:00 a.m. the next day. The file is named yymmdd.TPL (daily file) and is available in the Health Plan's folder under AZ/hpmnemonic/PROD/OUT. It will contain both TPL and Medicare data.
TPL Daily Invalid Notification files	contains invalid TPL referrals that are downloaded to the AHCCCS Communications Server and available for extraction by the Health Plan by 7:00 a.m. the next day. The file is named yymmdd.NOT and is available in the Health Plan's folder under AZ/hpmnemonic/PROD/OUT. It will only contain TPL data.
TPL Verified data Monthly file	are downloaded to the AHCCCS Communications Server based upon the membership as of the first of the month and available for extraction by the Health Plan soon after the Monthly 834 files are made available. The file is named ccyymm.TPL and is available in the Health Plan's folder under AZ/hpmnemonic/PROD/OUT It will contain only TPL data
Master Carrier ID file	are downloaded to the AHCCCS Communications Server each Friday and available for extraction by the health Plan by 7:00 a.m. the next day. The file is named RFCARIDmmddyy.TXT and is available in the /AZ/ShareINFO/Reference/PROD/OUT folder.

Media

The TPL File is available on the AHCCCS communications server.

Testing

TPL file transmissions must be tested in coordination with AHCCCS ISD operations staff prior to production implementation of a new Health Plan or change in service bureau, or as a result of roster changes. Typical testing of transmissions takes approximately one week and must be completed prior to implementation of any new processing arrangement.

Reference documents