Technical Interface Guidelines


Codes and Values

 

RF401 RATE CODES

1000's

Code

Description

Eff Beg Date

Eff End Date

100A

TANF < 1 M & F WITH MEDICARE PPC

10/96

 

100B

TANF 01-05 M & F WITH MEDICARE PPC

10/96

 

100C

TANF 06-13 M & F WITH MEDICARE PPC

10/96

 

100D

TANF 14-20 MALE WITH MEDICARE PPC

10/96

 

100E

TANF 14-20 FEMALE WITH MEDICARE PPC

10/96

 

100F

TANF 21-44 MALE WITH MEDICARE PPC

10/96

 

100G

TANF 21-44 FEMALE WITH MEDICARE PPC

10/96

 

100H

TANF 44-64 M & F WITH MEDICARE PPC

10/96

 

100J

TANF 65+ M & F WITH MEDICARE PPC

10/96

 

100Z

TANF ALTCS WITH MEDICARE PPC

10/96

 

1000

TANF WITH MEDICARE

10/82

 

1001

TANF < 1 M & F WITH MEDICARE

10/97

 

1002

TANF 01-05 M & F WITH MEDICARE

10/97

 

1003

TANF 06-13 M & F WITH MEDICARE

10/97

 

1004

TANF 14-20 MALE WITH MEDICARE

10/97

 

1005

TANF 14-20 FEMALE WITH MEDICARE

10/97

 

1006

TANF 21-44 MALE WITH MEDICARE

10/97

 

1007

TANF 21-44 FEMALE WITH MEDICARE

10/97

 

1008

TANF 45-64 M & F WITH MEDICARE

10/97

 

1009

TANF 65+ M & F WITH MEDICARE

10/97

 

101A

TANF < 1 M & F NON-MEDICARE PPC

10/96

 

101B

TANF 01-05 M & F NON-MEDICARE PPC

10/96

 

101C

TANF 06-13 M & F NON-MEDICARE PPC

10/96

 

101D

TANF 14-20 MALE NON-MEDICARE PPC

10/96

 

101E

TANF 14-20 FEMALE NON-MEDICARE PPC

10/96

 

101F

TANF 21-44 MALE NON-MEDICARE PPC

10/96

 

101G

TANF 21-44 FEMALE NON-MEDICARE PPC

10/96

 

101H

TANF 44-64 M & F NON-MEDICARE PPC

10/96

 

101J

TANF 65+ N & F NON-MEDICARE PPC

10/96

 

101Z

TANF ALTCS NON-MEDICARE PPC

10/96

 

1010

TANF NON-MEDICARE

10/82

 

1011

TANF <1 M & F NON-MEDICARE

10/97

 

1012

TANF 01-05 M & F NON-MEDICARE

10/97

 

1013

TANF 06-13 M & F NON-MEDICARE

10/97

 

1014

TANF 14-20 MALE NON-MEDICARE

10/97

 

1015

TANF 14-20 FEMALE NON-MEDICARE

10/97

 

1016

TANF 21-44 MALE NON-MEDICARE

10/97

 

1017

TANF 21-44 FEMALE NON-MEDICARE

10/97

 

1018

TANF 45-64 M & F NON-MEDICARE

10/97

 

1019

TANF 65+ M & F NON-MEDICARE

10/97

 

102A

TANF < 1 M & F WITH QMB PPC

10/96

 

102B

TANF 01-05 M & F WITH QMB PPC

10/96

 

102C

TANF 06-13 M & F WITH QMB PPC

10/96

 

102D

TANF 14-20 MALE WITH QMB PPC

10/96

 

102E

TANF 14-20 FEMALE WITH QMB PPC

10/96

 

102F

TANF 21-44 MALE WITH QMB PPC

10/96

 

102G

TANF 21-44 FEMALE WITH QMB PPC

10/96

 

102H

TANF 44-64 M & F WITH QMB PPC

10/96

 

102J

TANF 65+ M & F WITH QMB PPC

10/96

 

102Z

TANF ALTCS WITH QMB PPC

10/96

 

1020

TANF WITH QMB

01/89

 

1021

TANF <1 M & F WITH QMB

10/97

 

1022

TANF 01-05 M & F WITH QMB

10/97

 

1023

TANF 06-13 M & F WITH QMB

10/97

 

1024

TANF 14-20 MALE WITH QMB

10/97

 

1025

TANF 14-20 FEMALE WITH QMB

10/97

 

1026

TANF 21-44 MALE WITH QMB

10/97

 

1027

TANF 21-44 FEMALE WITH QMB

10/97

 

1028

TANF 45-64 M & F WITH QMB

10/97

 

1029

TANF 65+ M & F WITH QMB

10/97

 

110A

TANF EXPANDED <1 M & F W/MDC PPC

04/01

 

110B

TANF EXPANDED 01-05 M & F W/MDC PPC

04/01

 

110C

TANF EXPANDED 06-13 M & F W/MDC PPC

04/01

 

110D

TANF EXPANDED 14-20 MALE W/MDC PPC

04/01

 

110E

TANF EXPANDED 14-20 FEMALE W/MDC PPC

04/01

 

110F

TANF EXPANDED 21-44 MALE W/MDC PPC

04/01

 

110G

TANF EXPANDED 21-44 FEMALE W/MDC PPC

04/01

 

110H

TANF EXPANDED 45-64 M & F W/MDC PPC

04/01

 

110J

TANF EXPANDED 65+ M & F W/MDC

04/01

 

1101

TANF EXPANDED <1 M & F W/MDC

04/01

 

1102

TANF EXPANDED 01-05 M & F W/MDC

04/01

 

1103

TANF EXPANDED 06-13 M & F W/MDC

04/01

 

1104

TANF EXPANDED 14-20 MALE W/MDC

04/01

 

1105

TANF EXPANDED 14-20 FEMALE W/MDC

04/01

 

1106

TANF EXPANDED 21-44 MALE W/MDC

04/01

 

1107

TANF EXPANDED 21-44 FEMALE W/MDC

04/01

 

1108

TANF EXPANDED 45-64 M & F W/MDC

04/01

 

1109

TANF EXPANDED 65+ M & F W/MDC

04/01

 

111A

TANF EXPANDED <1 M & F NO MDC PPC

04/01

 

111B

TANF EXPANDED 01-05 M & F NO MDC PPC

04/01

 

111C

TANF EXPANDED 06-13 M & F NO MDC PPC

04/01

 

111D

TANF EXPANDED 14-20 MALE NO MDC PPC

04/01

 

111E

TANF EXPANDED 14-20 FEMALE NO MDC PPC

04/01

 

111F

TANF EXPANDED 21-44 MALE NO MDC PPC

04/01

 

111G

TANF EXPANDED 21-44 FEMALE NO MDC PPC

04/01

 

111H

TANF EXPANDED 45-64 M & F NO MDC PPC

04/01

 

111J

TANF EXPANDED 65+ M & F NO MDC PPC

04/01

 

1111

TANF EXPANDED <1 M & F NO MDC

04/01

 

1112

TANF EXPANDED 01-05 M & F NO MDC

04/01

 

1113

TANF EXPANDED 06-13 M & F NO MDC

04/01

 

1114

TANF EXPANDED 14-20 MALE NO MDC

04/01

 

1115

TANF EXPANDED 14-20 FEMALE NO MDC

04/01

 

1116

TANF EXPANDED 21-44 MALE NO MDC

04/01

 

1117

TANF EXPANDED 21-44 FEMALE NO MDC

04/01

 

1118

TANF EXPANDED 45-64 M & F NO MDC

04/01

 

1119

TANF EXPANDED 65+ M & F NO MDC

04/01

 

112A

TANF EXPANDED <1 M & F W/QMB PPC

04/01

 

112B

TANF EXPANDED 01-05 M & F W/QMB PPC

04/01

 

112C

TANF EXPANDED 06-13 M & F W/QMB PPC

04/01

 

112D

TANF EXPANDED 14-20 MALE W/QMB PPC

04/01

 

112E

TANF EXPANDED 14-20 FEMALE W/QMB PPC

04/01

 

112F

TANF EXPANDED 21-44 MALE W/QMB PPC

04/01

 

112G

TANF EXPANDED 21-44 FEMALE W/QMB PPC

04/01

 

112H

TANF EXPANDED 45-64 M & F W/QMB PPC

04/01

 

112J

TANF EXPANDED 65+ M & F W/QMB PPC

04/01

 

1121

TANF EXPANDED <1 M & F W/QMB

04/01

 

1122

TANF EXPANDED 01-05 M & F W/QMB

04/01

 

1123

TANF EXPANDED 06-13 M & F W/QMB

04/01

 

1124

TANF EXPANDED 14-20 MALE W/QMB

04/01

 

1125

TANF EXPANDED 14-20 FEMALE W/QMB

04/01

 

1126

TANF EXPANDED 21-44 MALE W/QMB

04/01

 

1127

TANF EXPANDED 21-44 FEMALE W/QMB

04/01

 

1128

TANF EXPANDED 45-64 M & F W/QMB

04/01

 

1129

TANF EXPANDED 65+ M & F W/QMB

04/01

 

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RF401 RATE CODES

2000's

Code

Description

Eff Beg Date

Eff End Date

210Z

SSI AGED WITH MEDICARE PPC

10/96

 

2100

SSI AGED WITH MEDICARE

10/82

 

211Z

SSI AGED NON-MEDICARE PPC

10/96

 

2110

SSI AGED NON-MEDICARE

10/82

 

212Z

SSI AGED WITH QMB PPC

10/96

 

2120

SSI AGED WITH QMB

01/89

 

220Z

SSI DISABLED WITH MEDICARE PPC

10/96

 

2200

SSI DISABLED WITH MEDICARE

10/82

 

221Z

SSI DISABLED NON-MEDICARE PPC

10/96

 

2210

SSI DISABLED NON-MEDICARE

10/82

 

222Z

SSI DISABLED WITH QMB PPC

10/96

 

2220

SSI DISABLED WITH QMB

01/89

 

230Z

SSI BLIND WITH MEDICARE PPC

10/96

 

2300

SSI BLIND WITH MEDICARE

10/82

 

231Z

SSI BLIND NON-MEDICARE PPC

10/96

 

2310

SSI BLIND NON-MEDICARE

10/82

 

232Z

SSI BLIND WITH QMB PPC

10/96

 

2320

SSI BLIND WITH QMB

01/89

 

240Z

SSI AGED EXPANDED WITH MEDICARE PPC

04/01

 

2400

SSI AGED EXPANDED WITH MEDICARE

04/01

 

241Z

SSI AGED EXPANDED NO MDC PPC

04/01

 

2410

SSI AGED EXPANDED NO MDC

04/01

 

242Z

SSI AGED EXPANDED WITH QMB PPC

04/01

 

2420

SSI AGED EXPANDED WITH QMB

04/01

 

250Z

SSI BLIND EXPANDED WITH MEDICARE PPC

04/01

 

2500

SSI BLIND EXPANDED WITH MEDICARE

04/01

 

251Z

SSI BLIND EXPANDED NO MDC PPC

04/01

 

2510

SSI BLIND EXPANDED NO MDC

04/01

 

252Z

SSI BLIND EXPANDED WITH QMB PPC

04/01

 

2520

SSI BLIND EXPANDED WITH QMB

04/01

 

260Z

SSI DISABLED EXPANDED WITH MDC PPC

04/01

 

2600

SSI DISABLED EXPANDED WITH MDC

04/01

 

261Z

SSI DISABLED EXPANDED NON-MDC PPC

04/01

 

2610

SSI DISABLED EXPANDED NON-MDC

04/01

 

262Z

SSI DISABLED EXPANDED WITH QMB PPC

04/01

 

2620

SSI DISABLED EXPANDED WITH QMB

04/01

 

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RF401 RATE CODES

3000's

Code

Description

Eff Beg Date

Eff End Date

300Z

MN/MI WITH MEDICARE PPC

10/96

  

3000

MN/MI WITH MEDICARE

10/82

 

301Z

MN/MI NON-MEDICARE PPC

10/96

 

3010

MN/MI NON-MEDICARE

10/82

 

330A

AHC CARE M & F <1 W/MDC PPC

10/01

 

330B

AHC CARE M & F 01-05 W/MDC PPC

10/01

 

330C

AHC CARE M & F 06-13 W/MDC PPC

10/01

 

330D

AHC CARE MALE 14-20 W/MDC PPC

10/01

 

330E

AHC CARE FEMALE 14-20 W/MDC PPC

10/01

 

330F

AHC CARE MALE 21-44 W/MDC PPC

10/01

 

330G

AHC CARE FEMALE 21-44 W/MDC PPC

10/01

 

330H

AHC CARE M & F 45-64 W/MDC PPC

10/01

 

330J

AHC CARE M & F 65+ W/MDC PPC

10/01

 

3301

AHC CARE M & F <1 W/MDC

10/01

 

3302

AHC CARE M & F 01-05 W/MDC

10/01

 

3303

AHC CARE M & F 06-13 W/MDC

10/01

 

3304

AHC CARE MALE 14-20 W/MDC

10/01

 

3305

AHC CARE FEMALE 14-20 W/MDC

10/01

 

3306

AHC CARE MALE 21-44 W/MDC

10/01

 

3307

AHC CARE FEMALE 21-44 W/MDC

10/01

 

3308

AHC CARE M & F 45-64 W/MDC

10/01

 

3309

AHC CARE M & F 65+ W/MDC

10/01

 

331A

AHC CARE M & F <1 NO-MED PPC

10/01

 

331B

AHC CARE M & F 01-05 NO-MED PPC

10/01

 

331C

AHC CARE M & F 06-13 NO-MED PPC

10/01

 

331D

AHC CARE MALE 14-20 NO-MED PPC

10/01

 

331E

AHC CARE FEMALE 14-20 NO-MED PPC

10/01

 

331F

AHC CARE MALE 21-44 NO-MED PPC

10/01

 

331G

AHC CARE FEMALE 21-44 NO-MED PPC

10/01

 

331H

AHC CARE M & F 45-64 NO-MED PPC

10/01

 

331J

AHC CARE M & F 65+ NO-MED PPC

10/01

 

3311

AHC CARE M & F <1 NO-MED

10/01

 

3312

AHC CARE M & F 01-05 NO-MED

10/01

 

3313

AHC CARE M & F 06-13 NO-MED

10/01

 

3314

AHC CARE MALE 14-20 NO-MED

10/01

 

3315

AHC CARE FEMALE 14-20 NO-MED

10/01

 

3316

AHC CARE MALE 21-44 NO-MED

10/01

 

3317

AHC CARE FEMALE 21-44 NO-MED

10/01

 

3318

AHC CARE M & F 45-64 NO-MED

10/01

 

3319

AHC CARE M & F 65+ NO-MED

10/01

 

332A

AHC CARE M & F <1 W/QMB PPC

10/01

 

332B

AHC CARE M & F 01-05 W/QMB PPC

10/01

 

332C

AHC CARE M & F 06-13 W/QMB PPC

10/01

 

332D

AHC CARE MALE 14-20 W/QMB PPC

10/01

 

332E

AHC CARE FEMALE 14-20 W/QMB PPC

10/01

 

332F

AHC CARE MALE 21-44 W/QMB PPC

10/01

 

332G

AHC CARE FEMALE 21-44 W/QMB PPC

10/01

 

332H

AHC CARE M & F 45-64 W/QMB PPC

10/01

 

332J

AHC CARE M & F 65+ W/QMB PPC

10/01

 

3321

AHC CARE M & F <1 W/QMB

10/01

 

3322

AHC CARE M & F 01-05 W/QMB

10/01

 

3323

AHC CARE M & F 06-13 W/QMB

10/01

 

3324

AHC CARE MALE 14-20 W/QMB

10/01

 

3325

AHC CARE FEMALE 14-20 W/QMB

10/01

 

3326

AHC CARE MALE 21-44 W/QMB

10/01

 

3327

AHC CARE FEMALE 21-44 W/QMB

10/01

 

3328

AHC CARE M & F 45-64 W/QMB

10/01

 

3329

AHC CARE M & F 65+ W/QMB

10/01

 

340Z

MED ELIGIBILITY W/MDC PPC

04/01

 

3400

MED ELIGIBILITY W/MDC

04/01

 

341Z

MED ELIGIBILITY NON-MDC PPC

04/01

 

3410

MED ELIGIBILITY NON-MDC

04/01

 

342Z

MED ELIGIBILITY W/QMB PPC

04/01

 

3420

MED ELIGIBILITY W/QMB

04/01

 

350A

AHC CARE HOSP M & F <1 W/MDC PPC

10/01

 

350B

AHC CARE HOSP M & F 01-05 W/MDC PPC

10/01

 

350C

AHC CARE HOSP M & F 06-13 W/MDC PPC

10/01

 

350D

AHC CARE HOSP MALE 14-20 W/MDC PPC

10/01

 

350E

AHC CARE HOSP FEMALE 14-20 W/MDC PPC

10/01

 

350F

AHC CARE HOSP MALE 21-44 W/MDC PPC

10/01

 

350G

AHC CARE HOSP FEMALE 21-44 W/MDC PPC

10/01

 

350H

AHC CARE HOSP M & F 45-64 W/MDC PPC

10/01

 

350J

AHC CARE HOSP M & F 65+ W/MDC PPC

10/01

 

3501

AHC CARE HOSP M & F <1 W/MDC

10/01

 

3502

AHC CARE HOSP M & F 01-05 W/MDC

10/01

 

3503

AHC CARE HOSP M & F 06-13 W/MDC

10/01

 

3504

AHC CARE HOSP MALE 14-20 W/MDC

10/01

 

3505

AHC CARE HOSP FEMALE 14-20 W/MDC

10/01

 

3506

AHC CARE HOSP MALE 21-44 W/MDC

10/01

 

3507

AHC CARE HOSP FEMALE 21-44 W/MDC

10/01

 

3508

AHC CARE HOSP M & F 45-64 W/MDC

10/01

 

3509

AHC CARE HOSP M & F 65+ W/MDC

10/01

 

351A

AHC CARE HOSP M & F <1 NO-MED PPC

10/01

 

351B

AHC CARE HOSP M & F 01-05 NO-MED PPC

10/01

 

351C

AHC CARE HOSP M & F 06-13 NO-MED PPC

10/01

 

351D

AHC CARE HOSP MALE 14-20 NO-MED PPC

10/01

 

351E

AHC CARE HOSP FEMALE 14-20 NO-MED PPC

10/01

 

351F

AHC CARE HOSP MALE 21-44 NO-MED PPC

10/01

 

351G

AHC CARE HOSP FEMALE 21-44 NO-MED PPC

10/01

 

351H

AHC CARE HOSP M & F 45-64 NO-MED PPC

10/01

 

351J

AHC CARE HOSP M & F 65+ NO-MED PPC

10/01

 

3511

AHC CARE HOSP M & F <1 NO-MED

10/01

 

3512

AHC CARE HOSP M & F 01-05 NO-MED

10/01

 

3513

AHC CARE HOSP M & F 06-13 NO-MED

10/01

 

3514

AHC CARE HOSP MALE 14-20 NO-MED

10/01

 

3515

AHC CARE HOSP FEMALE 14-20 NO-MED

10/01

 

3516

AHC CARE HOSP MALE 21-44 NO-MED

10/01

 

3517

AHC CARE HOSP FEMALE 21-44 NO-MED

10/01

 

3518

AHC CARE HOSP M & F 45-64 NO-MED

10/01

 

3519

AHC CARE HOSP M & F 65+ NO-MED

10/01

 

352A

AHC CARE HOSP M & F <1 W/QMB PPC

10/01

 

352A

AHC CARE HOSP M & F 01-05 W/QMB PPC

10/01

 

352C

AHC CARE HOSP M & F 06-13 W/QMB PPC

10/01

 

352D

AHC CARE HOSP MALE 14-20 W/QMB PPC

10/01

 

352E

AHC CARE HOSP FEMALE 14-20 W/QMB PPC

10/01

 

352F

AHC CARE HOSP MALE 21-44 W/QMB PPC

10/01

 

352G

AHC CARE HOSP FEMALE 21-44 W/QMB PPC

10/01

 

352H

AHC CARE HOSP M & F 45-64 W/QMB PPC

10/01

 

352J

AHC CARE HOSP M & F 65+ W/QMB PPC

10/01

 

3521

AHC CARE HOSP M & F <1 W/QMB

10/01

 

3522

AHC CARE HOSP M & F 01-05 W/QMB

10/01

 

3523

AHC CARE HOSP M & F 06-13 W/QMB

10/01

 

3524

AHC CARE HOSP MALE 14-20 W/QMB

10/01

 

3525

AHC CARE HOSP FEMALE 14-20 W/QMB

10/01

 

3526

AHC CARE HOSP MALE 21-44 W/QMB

10/01

 

3527

AHC CARE HOSP FEMALE 21-44 W/QMB

10/01

 

3528

AHC CARE HOSP M & F 45-64 W/QMB

10/01

 

3529

AHC CARE HOSP M & F 65+ W/QMB

10/01

 

360A

AHC CARE/MI M & F <1 W/MDC PPC

04/01

 

360B

AHC CARE/MI M & F 01-05 W/MDC PPC

04/01

 

360C

AHC CARE/MI M & F 06-13 W/MDC PPC

04/01

 

360D

AHC CARE/MI MALE 14-20 W/MDC PPC

04/01

 

360E

AHC CARE/MI FEMALE 14-20 W/MDC PPC

04/01

 

360F

AHC CARE/MI MALE 21-44 W/MDC PPC

04/01

 

360G

AHC CARE/MI FEMALE 21-44 W/MDC PPC

04/01

 

360H

AHC CARE/MI M & F 45-64 W/MDC PPC

04/01

 

360J

AHC CARE/MI M & F 65+ W/MDC PPC

04/01

 

3601

AHC CARE/MI M & F <1 W/MDC

04/01

 

3602

AHC CARE/MI M & F 01-05 W/MDC

04/01

 

3603

AHC CARE/MI M & F 06-13 W/MDC

04/01

 

3604

AHC CARE/MI MALE 14-20 W/MDC

04/01

 

3605

AHC CARE/MI FEMALE 14-20 W/MDC

04/01

 

3606

AHC CARE/MI MALE 21-44 W/MDC

04/01

 

3607

AHC CARE/MI FEMALE 21-44 W/MDC

04/01

 

3608

AHC CARE/MI M & F 45-64 W/MDC

04/01

 

3609

AHC CARE/MI M & F 65+ W/MDC

04/01

 

361A

AHC CARE/MI M & F <1 NO-MED PPC

04/01

 

361B

AHC CARE/MI M & F 01-05 NO-MED PPC

04/01

 

361C

AHC CARE/MI M & F 06-13 NO-MED PPC

04/01

 

361D

AHC CARE/MI MALE 14-20 NO-MED PPC

04/01

 

361E

AHC CARE/MI FEMALE 14-20 NO-MED PPC

04/01

 

361F

AHC CARE/MI MALE 21-44 NO-MED PPC

04/01

 

361G

AHC CARE/MI FEMALE 21-44 NO-MED PPC

04/01

 

361H

AHC CARE/MI M & F 45-64 NO-MED PPC

04/01

 

361J

AHC CARE/MI M & F 65+ NO-MED PPC

04/01

 

3611

AHC CARE/MI M & F <1 NO-MED

04/01

 

3612

AHC CARE/MI M & F 01-05 NO-MED

04/01

 

3613

AHC CARE/MI M & F 06-13 NO-MED

04/01

 

3614

AHC CARE/MI MALE 14-20 NO-MED

04/01

 

3615

AHC CARE/MI FEMALE 14-20 NO-MED

04/01

 

3616

AHC CARE/MI MALE 21-44 NO-MED

04/01

 

3617

AHC CARE/MI FEMALE 21-44 NO-MED

04/01

 

3618

AHC CARE/MI M & F 45-64 NO-MED

04/01

 

3619

AHC CARE/MI M & F 65+ NO-MED

04/01

 

362A

AHC CARE/MI M & F <1 W/QMB PPC

04/01

 

362B

AHC CARE/MI M & F 01-05 W/QMB PPC

04/01

 

362C

AHC CARE/MI M & F 06-13 W/QMB PPC

04/01

 

362D

AHC CARE/MI MALE 14-20 W/QMB PPC

04/01

 

362E

AHC CARE/MI FEMALE 14-20 W/QMB PPC

04/01

 

362F

AHC CARE/MI MALE 21-44 W/QMB PPC

04/01

 

362G

AHC CARE/MI FEMALE 21-44 W/QMB PPC

04/01

 

362H

AHC CARE/MI M & F 45-64 W/QMB PPC

04/01

 

362J

AHC CARE/MI M & F 65+ W/QMB PPC

04/01

 

3621

AHC CARE/MI M & F <1 W/QMB

04/01

 

3622

AHC CARE/MI M & F 01-05 W/QMB

04/01

 

3623

AHC CARE/MI M & F 06-13 W/QMB

04/01

 

3624

AHC CARE/MI MALE 14-20 W/QMB

04/01

 

3625

AHC CARE/MI FEMALE 14-20 W/QMB

04/01

 

3626

AHC CARE/MI MALE 21-44 W/QMB

04/01

 

3627

AHC CARE/MI FEMALE 21-44 W/QMB

04/01

 

3628

AHC CARE/MI M & F 45-64 W/QMB

04/01

 

3629

AHC CARE/MI M & F 65+ W/QMB

04/01

 

370A

AHC CARE/MI HOSP M & F <1 W/MDC PPC

10/01

 

370B

AHC CARE/MI HOSP M & F 01-05 W/MDC PPC

10/01

 

370C

AHC CARE/MI HOSP M & F 06-13 W/MDC PPC

10/01

 

370D

AHC CARE/MI HOSP MALE 14-20 W/MDC PPC

10/01

 

370E

AHC CARE/MI HOSP FEMALE 14-20 W/MDC PPC

10/01

 

370F

AHC CARE/MI HOSP MALE 21-44 W/MDC PPC

10/01

 

370G

AHC CARE/MI HOSP FEMALE 21-44 W/MDC PPC

10/01

 

370H

AHC CARE/MI HOSP M & F 45-64 W/MDC PPC

10/01

 

370J

AHC CARE/MI HOSP M & F 65+ W/MDC PPC

10/01

 

3701

AHC CARE/MI HOSP M & F <1 W/MDC

10/01

 

3702

AHC CARE/MI HOSP M & F 01-05 W/MDC

10/01

 

3703

AHC CARE/MI HOSP M & F 06-13 W/MDC

10/01

 

3704

AHC CARE/MI HOSP MALE 14-20 W/MDC

10/01

 

3705

AHC CARE/MI HOSP FEMALE 14-20 W/MDC

10/01

 

3706

AHC CARE/MI HOSP MALE 21-44 W/MDC

10/01

 

3707

AHC CARE/MI HOSP FEMALE 21-44 W/MDC

10/01

 

3708

AHC CARE/MI HOSP M & F 45-64 W/MDC

10/01

 

3709

AHC CARE/MI HOSP M & F 65+ W/MDC

10/01

 

371A

AHC CARE/MI HOSP M & F <1 NO-MED PPC

10/01

 

371B

AHC CARE/MI HOSP M & F 01-05 NO-MED PPC

10/01

 

371C

AHC CARE/MI HOSP M & F 06-13 NO-MED PPC

10/01

 

371D

AHC CARE/MI HOSP MALE 14-20 NO-MED PPC

10/01

 

371E

AHC CARE/MI HOSP FEMALE 14-20 NO-MED PPC

10/01

 

371F

AHC CARE/MI HOSP MALE 21-44 NO-MED PPC

10/01

 

371G

AHC CARE/MI HOSP FEMALE 21-44 NO-MED PPC

10/01

 

371H

AHC CARE/MI HOSP M & F 45-64 NO-MED PPC

10/01

 

371J

AHC CARE/MI HOSP M & F 65+ NO-MED PPC

10/01

 

3711

AHC CARE/MI HOSP M & F <1 NO-MED

10/01

 

3712

AHC CARE/MI HOSP M & F 01-05 NO-MED

10/01

 

3713

AHC CARE/MI HOSP M & F 06-13 NO-MED

10/01

 

3714

AHC CARE/MI HOSP MALE 14-20 NO-MED

10/01

 

3715

AHC CARE/MI HOSP FEMALE 14-20 NO-MED

10/01

 

3716

AHC CARE/MI HOSP MALE 21-44 NO-MED

10/01

 

3717

AHC CARE/MI HOSP FEMALE 21-44 NO-MED

10/01

 

3718

AHC CARE/MI HOSP M & F 45-64 NO-MED

10/01

 

3719

AHC CARE/MI HOSP M & F 65+ NO-MED

10/01

 

372A

AHC CARE/MI HOSP M & F <1 W/QMB PPC

10/01

 

372B

AHC CARE/MI HOSP M & F 01-05 W/QMB PPC

10/01

 

372C

AHC CARE/MI HOSP M & F 06-13 W/QMB PPC

10/01

 

372D

AHC CARE/MI HOSP MALE 14-20 W/QMB PPC

10/01

 

372E

AHC CARE/MI HOSP FEMALE 14-20 W/QMB PPC

10/01

 

372F

AHC CARE/MI HOSP MALE 21-44 W/QMB PPC

10/01

 

372G

AHC CARE/MI HOSP FEMALE 21-44 W/QMB PPC

10/01

 

372H

AHC CARE/MI HOSP M & F 45-64 W/QMB PPC

10/01

 

372J

AHC CARE/MI HOSP M & F 65+ W/QMB PPC

10/01

 

3721

AHC CARE/MI HOSP M & F <1 W/QMB

10/01

 

3722

AHC CARE/MI HOSP M & F 01-05 W/QMB

10/01

 

3723

AHC CARE/MI HOSP M & F 06-13 W/QMB

10/01

 

3724

AHC CARE/MI HOSP MALE 14-20 W/QMB

10/01

 

3725

AHC CARE/MI HOSP FEMALE 14-20 W/QMB

10/01

 

3726

AHC CARE/MI HOSP MALE 21-44 W/QMB

10/01

 

3727

AHC CARE/MI HOSP FEMALE 21-44 W/QMB

10/01

 

3728

AHC CARE/MI HOSP M & F 45-64 W/QMB

10/01

 

3729

AHC CARE/MI HOSP M & F 65+ W/QMB

10/01

 

380Z

MED HOSPITALIZED W/MDC PPC

10/01

 

3800

MED HOSPITALIZED W/MDC

10/01

 

381Z

MED HOSPITALIZED NON-MDC PPC

10/01

 

3810

MED HOSPITALIZED NON-MDC

10/01

 

382Z

MED HOSPITALIZED W/QMB PPC

10/01

 

3820

MED HOSPITALIZED W/MDC

10/01

 

Back To Top 


 

RF401 RATE CODES

4000's

Code

Description

Eff Beg Date

Eff End Date

410A

EAC < 1 M & F WITH MEDICARE PPC

10/96

 

410B

EAC 01-05 M & F WITH MEDICARE PPC

10/96

 

410C

EAC 06-13 M & F WITH MEDICARE PPC

10/96

 

410D

EAC 14-20 MALE WITH MEDICARE PPC

10/96

 

410E

EAC 14-20 FEMALE WITH MEDICARE PPC

10/96

 

4100

EAC WITH MEDICARE

01/87

09/97

4101

EAC <1 M & F WITH MEDICARE

10/97

 

4102

EAC 01-05 M & F WITH MEDICARE

10/97

 

4103

EAC 06-13 M & F WITH MEDICARE

10/97

 

4104

EAC 14-20 MALE WITH MEDICARE

10/96

 

4105

EAC 14-20 FEMALE WITH MEDICARE

10/96

 

411A

EAC < 1 M & F NON-MEDICARE PPC

10/96

 

411B

EAC 01-05 M & F NON-MEDICARE PPC

10/96

 

411C

EAC 06-13 M & F NON-MEDICARE PPC

10/96

 

411D

EAC 14-20 MALE NON-MEDICARE PPC

10/96

 

411E

EAC 14-20 FEMALE NON-MEDICARE PPC

10/96

 

4110

EAC NON-MEDICARE

01/87

09/97

4111

EAC <1 M & F NON-MEDICARE

10/97

 

4112

EAC 01-05 M & F NON-MEDICARE

10/97

 

4113

EAC 06-13 M & F NON-MEDICARE

10/97

 

4114

EAC 14-20 MALE NON-MEDICARE

10/96

 

4115

EAC 14-20 FEMALE NON-MEDICARE

10/96

  

420A

ELIC < 1 M & F WITH MEDICARE PPC

10/96

 

420B

ELIC 01-05 M & F WITH MEDICARE PPC

10/96

 

420C

ELIC 06-13 M & F WITH MEDICARE PPC

10/96

 

420D

ELIC 14-20 MALE WITH MEDICARE PPC

10/96

 

420E

ELIC 14-20 FEMALE WITH MEDICARE PPC

10/96

 

4200

ELIC WITH MEDICARE

01/87

09/97

4201

ELIC <1 M & F WITH MEDICARE

10/97

 

4202

ELIC 01-05 M & F WITH MEDICARE

10/97

 

4203

ELIC 06-13 M & F WITH MEDICARE

10/97

 

4204

ELIC 14-20 MALE WITH MEDICARE

10/96

 

4205

ELIC 14-20 FEMALE WITH MEDICARE

10/96

 

421A

ELIC < 1 M & F NON-MEDICARE PPC

10/96

 

421B

ELIC 01-05 M & F NON-MEDICARE PPC

10/96

 

421C

ELIC 06-13 M & F NON-MEDICARE PPC

10/96

 

421D

ELIC 14-20 MALE NON-MEDICARE PPC

10/96

 

421E

ELIC 14-20 FEMALE NON-MEDICARE PPC

10/96

 

4210

ELIC NON-MEDICARE

01/87

09/97

4211

ELIC <1 M & F NON-MEDICARE

10/97

 

4212

ELIC 01-05 M & F NON-MEDICARE

10/97

 

4213

ELIC 06-13 M & F NON-MEDICARE

10/97

 

4214

ELIC 14-20 MALE NON-MEDICARE

10/96

 

4215

ELIC 14-20 FEMALE NON-MEDICARE

10/96

 

430A

SOBRA CHILD < 1 M & F W/MEDICARE PPC

10/96

 

430B

SOBRA CHILD 01-05 M & F W/MEDICARE PPC

10/96

 

430C

SOBRA CHILD 06-13 M & F W/MEDICARE PPC

10/96

 

430D

SOBRA CHILD 14-20 MALE W/MEDICARE PPC

10/96

 

430E

SOBRA CHILD 14-20 FEMALE W/MEDICARE PPC

10/96

 

4300

SOBRA CHILD WITH MEDICARE

01/88

09/97

4301

SOBRA CHILD <1 M & F W/MEDICARE

10/97

 

4302

SOBRA CHILD 01-05 M & F W/MEDICARE

10/97

 

4303

SOBRA CHILD 06-13 M & F W/MEDICARE

10/97

 

4304

SOBRA CHILD 14-20 MALE W/MEDICARE

10/97

 

4305

SOBRA CHILD 14-20 FEMALE W/MEDICARE

10/97

 

431A

SOBRA CHILD < 1 M & F NON-MEDICARE PPC

10/96

 

431B

SOBRA CHILD 01-05 M & F NON-MEDICARE PPC

10/96

 

431C

SOBRA CHILD 06-13 M & NON-MEDICARE PPC

10/96

 

431D

SOBRA CHILD 14-20 MALE NON-MEDICARE PPC

10/96

 

431E

SOBRA CHILD 14-20 FEMALE NON-MEDICARE PP

10/96

 

4310

SOBRA CHILD NON-MEDICARE

01/88

09/97

4311

SOBRA CHILD <1 M & F NON-MEDICARE

10/97

 

4312

SOBRA CHILD 01-05 M & F NON-MEDICARE

10/97

 

4313

SOBRA CHILD 06-13 M & F NON-MEDICARE

10/97

 

4314

SOBRA CHILD 14-20 MALE NON-MEDICARE

10/97

 

4315

SOBRA CHILD 14-20 FEMALE NON-MEDICARE

10/97

 

432A

SOBRA CHILD < 1 M & F WITH QMB PPC

10/96

 

432B

SOBRA CHILD 01-05 M & F WITH QMB PPC

10/96

 

432C

SOBRA CHILD 06-13 M & F WITH QMB PPC

10/96

 

432D

SOBRA CHILD 14-20 MALE WITH QMB PPC

10/96

 

432E

SOBRA CHILD 14-20 FEMALE WITH QMB PPC

10/96

 

4320

SOBRA CHILD WITH QMB

01/88

09/97

4321

SOBRA CHILD <1 M & F WITH QMB

10/97

 

4322

SOBRA CHILD 01-05 M & F WITH QMB

10/97

 

4323

SOBRA CHILD 06-13 M & F WITH QMB

10/97

 

4324

SOBRA CHILD 14-20 MALE WITH QMB

10/97

 

4325

SOBRA CHILD 14-20 FEMALE WITH QMB

10/97

 

Back To Top


 

RF401 RATE CODES

5000's

Code

Description

Eff Beg Date

Eff End Date

500C

SOBRA PREG 09-13 FEMALE W/MEDICARE PPC

10/96

 

500E

SOBRA PREG 14-20 FEMALE W/MEDICARE PPC

10/96

 

500G

SOBRA PREG 21-44 FEMALE W/MEDICARE PPC

10/96

 

500H

SOBRA PREG 45-64 FEMALE W/MEDICARE PPC

10/96

 

5000

SOBRA PREGNANT WOMAN WITH MEDICARE

01/88

09/97

5003

SOBRA PREG 09-13 FEMALE WITH MEDICARE

10/97

 

5005

SOBRA PREG 14-20 FEMALE WITH MEDICARE

10/97

 

5007

SOBRA PREG 21-44 FEMALE WITH MEDICARE

10/97

 

5008

SOBRA PREG 45-64 FEMALE WITH MEDICARE

10/97

 

501C

SOBRA PREG 09-13 FEMALE NON-MEDICARE PPC

10/96

 

501E

SOBRA PREG 14-20 FEMALE NON-MEDICARE PPC

10/96

 

501G

SOBRA PREG 21-44 FEMALE NON-MEDICARE PPC

10/96

 

501H

SOBRA PREG 45-64 FEMALE NON-MEDICARE PPC

10/96

 

5010

SOBRA PREGNANT WOMAN NON-MEDICARE

01/88

09/97

5013

SOBRA PREG 09-13 FEMALE NON-MEDICARE

10/97

 

5015

SOBRA PREG 14-20 FEMALE NON-MEDICARE

10/97

 

5017

SOBRA PREG 21-44 FEMALE NON-MEDICARE

10/97

 

5018

SOBRA PREG 45-64 FEMALE NON-MEDICARE

10/97

  

502C

SOBRA PREG 09-13 FEMALE WITH QMB PPC

10/96

 

502E

SOBRA PREG 14-20 FEMALE WITH QMB PPC

10/96

 

502G

SOBRA PREG 21-44 FEMALE WITH QMB PPC

10/96

 

502H

SOBRA PREG 45-64 FEMALE WITH QMB PPC

10/96

 

5020

SOBRA PREGNANT WOMAN WITH QMB

01/88

09/97

5023

SOBRA PREG 09-13 FEMALE WITH QMB

10/97

 

5025

SOBRA PREG 14-20 FEMALE WITH QMB

10/97

 

5027

SOBRA PREG 21-44 FEMALE WITH QMB

10/97

 

5028

SOBRA PREG 45-64 FEMALE WITH QMB

10/97

 

5500

SOBRA FPS FEMALE WITH MEDICARE

10/97

 

5510

SOBRA FPS FEMALE WITH NON-MEDICARE

10/97

 

5520

SOBRA FPS FEMALE WITH QMB

10/97

 

Back To Top


 

RF401 RATE CODES

6000's

Code

Description

Eff Beg Date

Eff End Date

6011

KIDS <1 M/F NON-MEDICARE

11/98

 

6012

KIDS 1-5 M&F NON-MEDICARE

11/98

 

6013

KIDS 6-13 M&F NON-MEDICARE

11/98

 

6014

KIDS 14-19 MALE NON-MEDICARE

11/98

 

6015

KIDS 14-19 FEMALE NON-MEDICARE

11/98

 

6514

SOBRA HIFA 14-20 MALE NON-MEDICARE

10/01/02

 

6515

SOBRA HIFA 14-20 FEMALE NON-MEDICARE

10/01/02

 

6516

SOBRA HIFA 21-44 MALE NON-MEDICARE

10/01/02

 

6517

SOBRA HIFA 21-44 FEMALE NON-MEDICARE

10/01/02

 

6518

SOBRA HIFA 45-64 MALE/FEMALE NON-MEDICARE

10/01/02

 

6519

SOBRA HIFA 65+ MALE/FEMALE NON-MEDICARE

10/01/02

 

6614

KC HIFA 14-20 MALE NON-MEDICARE

10/01/02

 

6615

KC HIFA 14-20 FEMALE NON-MEDICARE

10/01/02

 

6616

KC HIFA 21-44 MALE NON-MEDICARE

10/01/02

 

6617

KC HIFA 21-44 FEMALE NON-MEDICARE

10/01/02

 

6618

KC HIFA 45-64 MALE/FEMALE NON-MEDICARE

10/01/02

 

6619

KC HIFA 65+ MALE/FEMALE NON-MEDICARE

10/01/02

 

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RF401 RATE CODES

7000's

Code

Description

Eff Beg Date

Eff End Date

7000

CMHS

11/92

 

7100

SMI

11/92

 

7200

CMHS/DD/18-20

11/92

 

7300

CMHS/SED

11/92

 

7400

GENERAL MENTAL HEALTH SERVICES

10/95

 

7600

SUBSTANCE ABUSE MENTAL HEALTH SERVICES

10/95

 

Back To Top


 

RF401 RATE CODES

8000's

Code

Description

Eff Beg Date

Eff End Date

8020

QMB ONLY

07/89

 

850Z

SSI AGED TICKET/WORK W/MDC PPC

10/01

 

8500

SSI AGED TICKET/WORK W/MDC

10/01

 

851Z

SSI AGED TICKET/WORK NON-MDC PPC

10/01

 

8510

SSI AGED TICKET/WORK NON-MDC

10/01

 

852Z

SSI AGED TICKET/WORK W/QMB PPC

10/01

 

8520

SSI AGED TICKET/WORK W/QMB

10/01

 

860Z

SSI BLIND TICKET/WORK W/MDC PPC

10/01

 

8600

SSI BLIND TICKET/WORK W/MDC

10/01

 

861Z

SSI BLIND TICKET/WORK NON-MDC PPC

10/01

 

8610

SSI BLIND TICKET/WORK NON-MDC

10/01

 

862Z

SSI BLIND TICKET/WORK W/QMB PPC

10/01

 

8620

SSI BLIND TICKET/WORK W/QMB

10/01

 

870Z

SSI DISABLED TICKET/WORK W/MDC PPC

10/01

 

8700

SSI DISABLED TICKET/WORK W/MDC

10/01

 

871Z

SSI DISABLED TICKET/WORK NON-MDC PPC

10/01

 

8710

SSI DISABLED TICKET/WORK NON-MDC

10/01

 

872Z

SSI DISABLED TICKET/WORK W/QMB PPC

10/01

 

8720

SSI DISABLED TICKET/WORK W/QMB

10/01

 

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RF401 RATE CODES

9000's

Code

Description

Eff Beg Date

Eff End Date

9900

HOSPITALIZED KICK PAYMENT

10/01

 

9910

TANF & SOBRA CHILDREN KICK PAYMENT

10/99

 

9911

SB PAYMENT FOR TANF EXPANDED

07/01

 

9920

SSI W/MEDICARE KICK PAYMENT

10/99

 

9921

SSI W/O MEDICARE KICK PAYMENT

10/99

 

9922

SB PAYMENT FOR SSI EXPANDED W/MDC

04/01

 

9923

SB PAYMENT FOR SSI EXPANDED NO MDC

04/01

 

9930

EAC/ELIC * MN/MI KICK PAYMENT

10/99

 

9933

SB PAYMENT FOR AHCCCS CARE

10/01

 

9934

SB PAYMENT FOR MED ELIGIBLES

04/01

 

9935

SB PAYMENT FOR AHC CARE HOSPITALIZED

10/01

 

9936

SB PAYMENT FOR AHC CARE/MI

04/01

 

9937

SB PAYMENT FOR AHC CARE/MI HOSPITALIZED

10/01

 

9938

SB PAYMENT FOR MED HOSPITALIZED

10/01

 

9950

SOBRA WOMAN KICK PAYMENT

10/99

 

9960

KIDSCARE KICK PAYMENT

10/99

 

9990

SOBRA SUPPLEMENTAL PMT

10/97

 

9997

SOBRA SUPP PAYMENT (SPEC. CAP)

01/88

09/97

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INSURED RELATIONSHIP

CODE

DESCRIPTION

A

ABSENT PARENT (CSEA)

C

CHILD

G

GUARANTOR

L

LEGAL GUARDIAN

O

OTHER

P

PARENT

S

SELF

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MEDICAL CONDITION

CODE

DESCRIPTION

BB

BED-BOUND

CC

LTC FACILITY CONV CARE

CH

CHEMOTHERAPY

DI

DIALYSIS

ER

ER-ACC/INJURY RELATED

HA

HOSPITALIZED-ACC/INJ REL

HI

HEAD INJURY

HK

HOSPITALIZED - KICK PAYMENT

HS

HOSPITALIZED

NN

NB-NORMAL

OA

OUTPATIENT-ACC/INJ RELAT

PG

PREGNANT

PR

PREGNANT-HIGH RISK

RT

RADIATION THERAPY

SI

SPINAL CORD INJURY

SN

NB-SICK

ST

SURGICAL STERILIZATION

TP

TRANSPLANTS

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COUNTY CODES (COUNTY TO GSA)
AS OF 10/01/1997

COUNTY

DESCRIPTION

GSA

01

APACHE

16

03

COCHISE

18

05

COCONINO

06

07

GILA

08

09

GRAHAM

14

11

GREENLEE

14

13

MARICOPA

12

15

MOHAVE

04

17

NAVAJO

16

19

PIMA

10

21

PINAL

08

23

SANTA CRUZ

18

25

YAVAPAI

06

27

YUMA

02

29

LA PAZ

04

31

OUT OF STATE  

33

OUT OF COUNTRY  

35

UNKNOWN  

99

STATEWIDE (FOR PRICING)  

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RECIPIENT ACTION TRANSACTION CODE

 RF403 ACTION RETROACTIVE

CODE

DESCRIPTION

TYPE

INDICATOR

$P

MANUAL PAYMENT

A

Y

$R

MANUAL RECOUPMENT

D

Y

AA

ALGORITHM ASSIGNED

A

N

AC

ADDRESS CHANGE

C

N

AE

APPLIED FOR NEW ELIGIBLITY

D

Y

AI

ADMIN-IN

A

N

AO

ADMIN-OUT

D

Y

BI

ENROLLMENT BLOCK IN

A

N

BO

ENROLLMENT BLOCK OUT

D

Y

CH

ELIG CHANGE CAUSES DISENRL

D

Y

CI

COUNTY MOVE-IN

A

N

CO

COUNTY MOVE-OUT

D

Y

DB

DATE OF BIRTH CHANGE

C

N

DE

DECEASED

D

Y

EC

ENROLLMENT CHOICE

A

N

EI

OPEN ENROLLMENT-IN

A

N

EO

OPEN ENROLLMENT-OUT

D

Y

FI

FAMILY CONTINUITY-IN

A

N

FO

FAMILY CONTINUITY-OUT

D

Y

HC

ACUTE HEALTH PLAN CHANGE

C

N

HK

HOSPITALIZED, KICK TO BE PAID    

HO

MOVE OUT OF HEALTH PLAN AREA

D

Y

IE

INELIGIBLE

D

Y

MA

MASS ADJUSTMENT RECOUPMENT

D

Y

MC

MENTAL HEALTH CHANGE

C

N

MI

MEDICAL CARE CONTINUITY-IN

A

N

MO

MEDICAL CARE CONTINUITY-OUT

D

Y

MR

MASS ADJUSTMENT PAYMENT

A

Y

NB

NEWBORN

A

N

NC

NAME CHANGE

C

N

NE

NORMAL ENROLLMENT

A

N

NP

NORMAL ENROLLMENT-PRIOR PLAN

A

N

OS

OUT OF STATE MOVE

D

Y

PA

END OF CONTRACT-IN: AUTO ASSIGN

A

N

PD

END OF CONTRACT-IN: DIRECT MOVE

A

N

PG

PREGNANT WOMEN

C

N

PO

END OF CONTRACT-OUT: DIRECT MOVE

D

Y

PP

END OF CONTRACT-IN: PERCENTAGE

A

N

PR

END OF CONTRACT-IN: RULE MATRIX

A

N

PT

END OF CONTRACT-OUT: %, AUTO, RULE

D

Y

RA

RETROACTIVE ENROLLMENT

A

N

RC

RATE CODE CHANGE

C

N

RE

RE-ENROLLMENT

A

N

RO

RECOUPMENT MHS

D

Y

SB

SUPPLEMENTAL BIRTH PAYMENT

C

N

SC

SHARE OF COST CHANGE

C

N

SX

SEX CHANGE

C

N

TM

MENTAL HEALTH TERMINATION

C

N

VW

VOLUNTARY WITHDRAWAL

D

Y

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CONTRACT TYPE

RF410

Type

Contract
Code

Description

CAP
Ind

FFS
Ind

%

CRS/CAP

Children's Rehab Services, Capitation

Y

N

@

DES/DD/RI

DES DD Reinsurance Indicator

N

N

A

ACU/CAP

Acute Capitated

Y

N

B

ACU/CAP/PAR

Acute Partially Capitated

Y

Y

C

ACU/CAP/ACU

Acute Capitated Acute SVCS Only

Y

N

D

ACU/FFS/ACU

Acute Fee for Service Acute Only

N

Y

E

ACU/FFS

Acute Fee for Service

N

Y

F

ACU/FFS/EMO

Acute FFS Emergency Services Only

N

Y

G

ACU/FFS/FPS

Acute Fee For Service, Family Planning Services

N

Y

H

ACU/PPC

Acute Prior Period Coverage

Y

N

I

ACU/PPC/EMO

Acute Prior Period Coverage Emergency Svcs

Y

N

J

LTC/CAP

Long Term Care Capitated

Y

N

K

MHS/CAP/ACU

Mental Health Svcs, Cap Acute Only

Y

N

L

LTC/CAP/ACU

Long Term Care Cap Acute Only

Y

N

M

LTC/PPC

Long Term Care Prior Period Coverage

Y

N

N

ACU/NBN

Acute Newborn Non-Capped

N

N

O

LTC/PPC/ACU

Long Term Care Prior Period Coverage Acute

Y

N

P

LTC/CAP/PAR

Long Term Care Partial Cap

Y

Y

Q

ACU/CAP/FPS

Acute Capitated FPS Only

Y

N

R

LTC/FFS

Long Term Care FFS

N

Y

S

MHS/CAP/DD

Mental Health Services Cap DD

Y

N

T

LTC/FFS/ACU

Long Term Care FFS Acute Only

Y

Y

U

UNDOC/FFS/EM

Undoc. Aliens, FFS, Emg Svc Only

N

Y

V

MHS/Cap/KC

Mental Health Services Capitated Kidscare

Y

N

W

ACU/KC/NoPay

ADHS Direct Services Kidscare No Payment

N

N

X

ACU/FFS/KC

Acute FFS Kidscare

N

Y

Y

ACU/CAP/KC

Acute Capitated Kidscare

Y

N

2

LTC/VD/CAP/F

LTC Vent Dependent Cap Full Svc

Y

N

3

LTC/FFS/VD

Long Term Care FFS VD

Y

Y

4

LTC/VD/CAP/A

LTC Vent Dependent Cap Acute Svc

Y

N

5

LTC/FFS/VHA

Long Term Care FFS VD Acute Only

Y

Y

8

NON/PAY

No Payment Permitted

N

N

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ELIGIBILITY CATEGORY

RF509

CODE

DESCRIPTION

AF

AFDC

EA

EAC

EL

ELIC

FP

SOBRA Women Family Planning Services

MI

Medically Indigent

MN

Medically Needy

QA

QMB Only Aged

QB

QMB Only Blind

QD

QMB Only Disabled

QO

QMB Only Other

SA

SSI Aged

SB

SSI Blind

SD

SSI Disabled

SF

State Funded

SI

SSI

SO

Sobra Woman

TA

TANF

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