Health Plan Interface

Third Party Liability Daily Verified Data File Layout

FIELD NAME	TYPE	SIZE	REMARKS
HEADER RECORD
Header Info	X	6	"TPLHDR"
Processing Date	X	8	(ccyymmdd)
Filler	X	396
DETAIL RECORD
Sequence number	X	2	TPL sequence number Sequentially assigned number except for Medicare: 50 = Medicare Part A 51 = Medicare Part B
Processing date	X	6	YYMMDD
AHCCCS ID	X	9	Member's AHCCCS ID number
Last Name	X	20	Member's Last Name
First Name	X	10	Member's First Name
Gender	X	1	Member's gender
Date of Birth	X	8	Member's date of birth (ccyymmdd)
Policy ID	X	20	Policy ID number or Medicare Claim number
Insurance Type	X	1	Insurance Type M=Medical P=Pharmacy S=Medicare Supplemental
Begin Date	X	8	Policy Begin Date (ccyymmdd)
End Date	X	8	Policy End Date (ccyymmdd)
Carrier Name	X	30	Carrier Name
Carrier Phone	X	10	Carrier Phone Number (Not used for Medicare records)
Carrier Street Address 1	X	23	Carrier Address (Not used for Medicare records)
Carrier Street Address 2	X	23	Carrier Address (Not used for Medicare records)
Carrier City	X	18	Carrier Address City (Not used for Medicare records)
Carrier State	X	2	Carrier Address State (Not used for Medicare records)
Carrier Zip Code	X	9	Carrier Address Zip Code (Not used for Medicare records)
Insured Name	X	31	Insured Name (Not used for Medicare records)
Insured & Patient Relationship	X	1	Relationship to policy holder (Not used for Medicare records) A-Absent Parent C-Child G-Guarantor L-Legal Guardian O-Other P-Parent S-Self
Insured Employer	X	30	Insured employer (Not used for Medicare records)
Insured Group Number	X	20	Insured Group Number (Not used for Medicare records)
Date Record Added	X	8	Date record was added (Not used for Medicare records)
Date Last Modified	X	8	Date record was last changed (Not used for Medicare records)
Date Verified	X	8	Date record was verified (Not used for Medicare records)
HP ID	X	6	Health Plan ID number
Filler	X	5	(To be used for future expansion of the Master Carrier ID)
Master Carrier ID	X	5	Master Carrier ID number from the Master Carrier reference file (Not used for Medicare records)
IRR	X	80	Invalid Record Reason message (for this file this field will most likely always be spaces)
TRAILER RECORD
Trailer Info	X	6	"TPLFTR"
Processing Date	X	8	(ccyymmdd)
Record Count	X	6	Total Number of Records
Filler	X	390

Third Party Invalid Daily Notification (NOT) File Layout

FIELD NAME	TYPE	SIZE	REMARKS
AHCCCS-ID	X	9	Member's AHCCCS ID number
Sequence number	U	2	TPL sequence number Sequentially assigned number
Policy ID	X	20	Policy ID number
Begin Date	X	8	Policy Begin Date (ccyymmdd)
End Date	X	8	Policy End Date (ccyymmdd)
Carrier Name	X	30	Carrier Name
Insured Name	X	31	Insured Name
Insured SSN	X	9	Insured SSN
Insured & Patient Relationship	X	1	Relationship to policy holder A-Absent Parent C-Child G-Guarantor L-Legal Guardian O-Other P-Parent S-Self
Insurance Type	X	1	Insurance Type M=Medical P=Pharmacy S=Medicare Supplemental
Carrier Phone	X	10	Carrier Phone Number
Change Reason	X	2	Reason coverage ended
Master Carrier ID	X	5	Master Carrier ID number from the Master Carrier reference file
Insured Employer	X	30	Insured employer
Insured Group Number	X	20	Insured Group Number
Carrier Street Address 1	X	23	Carrier Address
Carrier Street Address 2	X	23	Carrier Address
Carrier City	X	18	Carrier Address City
Carrier State	X	2	Carrier Address State
Carrier Zip Code	X	9	Carrier Address Zip Code
Date Verified	X	8
Status	X	1	Status of TPL Referral ‘I' = Invalid
Source	X	2	TPL Source
HP-ID	X	6	Health Plan ID number
IRR	X	80	Invalid Record Reason message

Third Party Liability Monthly Verified Data File Layout

FIELD NAME	TYPE	SIZE	REMARKS
Sequence number	X	2	TPL sequence number Medicare data not included
Processing date	X	6	YYMMDD
AHCCCS ID	X	9	Member's AHCCCS ID number
Last Name	X	20	Member's Last Name
First Name	X	10	Member's First Name
Gender	X	1	Member's gender
Date of Birth	X	8	Member's date of birth (ccyymmdd)
Policy ID	X	20	Policy ID number
Insurance Type	X	1	Insurance Type M=Medical P=Pharmacy S=Medicare Supplemental
Begin Date	X	8	Policy Begin Date (ccyymmdd)
End Date	X	8	Policy End Date (ccyymmdd)
Carrier Name	X	30	Carrier Name
Carrier Phone	X	10	Carrier Phone Number
Carrier Street Address 1	X	23	Carrier Address
Carrier Street Address 2	X	23	Carrier Address
Carrier City	X	18	Carrier Address City
Carrier State	X	2	Carrier Address State
Carrier Zip Code	X	9	Carrier Address Zip Code
Insured Name	X	31	Insured Name
Insured & Patient Relationship	X	1	Relationship to policy holder A-Absent Parent C-Child G-Guarantor L-Legal Guardian O-Other P-Parent S-Self
Insured Employer	X	30	Insured employer
Insured Group Number	X	20	Insured Group Number
Date Record Added	X	8	Date record was added (ccyymmdd)
Date Last Modified	X	8	Date record was last changed (ccyymmdd)
Date Verified	X	8	Date record was verified (ccyymmdd)
Health Plan ID	X	6	HP ID number
Filler	X	5	(To be used for future expansion of the Master Carrier ID)
Master Carrier ID	X	5	Master Carrier ID number from the Master Carrier reference file
IRR	X	80	Field not used

Master Carrier ID File Layout

FIELD NAME	TYPE	SIZE	REMARKS
Status	X	1	Record Status A-Active I-Inactive H-Historical
Carrier ID	X	10	Master Carrier ID Only the last five bytes are used
Filler	X	5	Filler
Carrier Name	X	25	Name of TPL Carrier
Address-Street 1	X	25	Line 1 Carrier's Mailing Address
Address-Street 2	X	25	Line 2 Carrier's Mailing Address
Address-City	X	25	City Carrier's Mailing Address
Address-State	X	2	State Carrier's Mailing Address
Address-Zip Code	X	9	Zip Code Carrier's Mailing Address
Filler	X	2
Business Phone	X	10	Carrier's Business Phone Number
Filler	X	1	Filler (ignore any data in this field)
Tribal Indicator	X	1	Tribal Insurance Indicator (Y/N)
Begin Date	X	8	Begin Date of record (ccyymmdd)
End Date	X	8	End Date of record (ccyymmdd)
Rec Added Date	X	8	Date record originally added (ccyymmdd)
Rec Added Time	X	8	Time record originally added (hhmmssss)
Rec Added User	X	3	User ID for record originally added
Last Mod Date	X	8	Date record last modified (ccyymmdd)
Last Mod Time	X	8	Time record last modified (hhmmssss)
Last Mod User	X	3	User ID for record last modified

Technical Interface Guidelines

Health Plan Interface

Third Party Liability Daily Verified Data File Layout

Third Party Invalid Daily Notification (NOT) File Layout

Third Party Liability Monthly Verified Data File Layout

Master Carrier ID File Layout