DATA
NAME |
TYPE |
SIZE |
REMARKS |
PROCESS DATE |
X |
8 |
CCYYMMDD |
CHOICE INDICATOR |
X |
1 |
J=JOINING
L=LEAVING |
NEW HEALTH PLAN ID |
X |
6 |
|
NEW HEALTH PLAN NAME |
X |
26 |
|
NEW COUNTY OF SERVICE CODE |
X |
2 |
|
NEW RATE CODE |
X |
4 |
|
PREVIOUS HEALTH PLAN ID |
X |
6 |
|
PREVIOUS HEALTH PLAN NAME |
X |
26 |
|
PREVIOUS COUNTY OF SERVICE |
X |
2 |
|
PREVIOUS RATE CODE |
X |
4 |
|
RECIPIENT AHCCCS ID |
X |
9 |
|
RECIPIENT LAST NAME |
X |
20 |
|
RECIPIENT FIRST NAME |
X |
10 |
|
RECIPIENT MIDDLE INITIAL |
X |
1 |
|
RCP. STREET ADDRESS LINE 1 |
X |
25 |
|
RCP. STREET ADDRESS LINE 2 |
X |
25 |
|
CITY |
X |
20 |
|
STATE |
X |
2 |
|
ZIP CODE |
X |
5 |
|
DATE OF BIRTH |
X |
8 |
CCYYMMDD |
NEW RECORD INDICATOR |
X |
1 |
N=NEW RECORD |
FILLER |
X |
25 |
|