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Technical Interface Guidelines

BHS Health Plan Interface

BHS Daily Third Party Liability File Layout

FIELD NAME

TYPE

SIZE

REMARKS
HEADER RECORD
Header Info X 6 "TPLHDR"
Processing Date X 8 (ccyymmdd)
Filler X 396  
DETAIL RECORD

SEQ-NO

X

2

TPL sequence number
   50 = Medicare Part A
   51 = Medicare Part B

PROCESS-DAT

X

6

(YYMMDD) Processing date

AHCCCS-ID

X

9

Member's AHCCCS ID

LAST-NAME

X

20

Member's Last Name

FIRST-NAME

X

10

Member's First Name

SEX

X

1

Member's Middle Initial

DAT-OF-BIR

X

8

Member's date of birth (CCYYMMDD)

POLICY-ID

X

20

Policy ID number or Medicare Claim number

INS-TYP

X

1

Insurance Type
M=Medical
P=Pharmacy
S=Medicare Supplemental

BEG-DAT

X

8

Policy Begin Date (CCYYMMDD)

END-DAT

X

8

Policy End Date (CCYYMMDD)

CAR-NAME

X

30

Carrier Name

CAR-PHONE

X

10

Carrier Phone Number
 (Not used for Medicare records)

CAR-STR-1

X

23

Carrier Address
(Not used for Medicare records)

CAR-STR-2

X

23

Carrier Address
(Not used for Medicare records)

CAR-CITY

X

18

Carrier Address City
(Not used for Medicare records)

CAR-ST

X

2

Carrier Address State
(Not used for Medicare records)

CAR-ZIP

X

9

Carrier Address Zip Code
(Not used for Medicare records)

INSURED-NAME

X

31

Insured Name
(Not used for Medicare records)
A-Absent Parent
C-Child G-Guarantor
L-Legal Guardian
O-Other
P-Parent
S-Self

INSURED-REL-PAT

X

1

Relationship to policy holder
(Not used for Medicare records)

INS-EMPR

X

30

Insured employer
(Not used for Medicare records)

INS-GRP-NUM

X

20

Insured Group Number
(Not used for Medicare records)

DAT-REC-ADDED

X

8

Date record was added
(Not used for Medicare records)

LAST-MOD-DAT

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 (MEDICAL)

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
(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  

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BHS Daily Notification File Layout

FIELD NAME

TYPE

SIZE

REMARKS

AHCCCS-ID

X

9

Member’s AHCCCS ID

SEQ-NO

U Z

2

TPL sequence number

POLICY-ID

X

20

Policy ID number or Medicare Claim number

BEG-DAT

X

8

Policy Begin Date (CCYYMMDD)

END-DAT

X

8

Policy End Date (CCYYMMDD)

CAR-NAME

X

30

Carrier Name

INSURED-NAME

X

31

Insured Name

INSURED-SSN

X

9

Insured SSN

INSURED-REL-PAT

X

1

Relationship to policy holder
A-Absent Parent
C-Child
G-Guarantor
L-Legal Guardian
O-Other
P-Parent
S-Self

INS-TYP

X

1

Insurance Type
M=Medical
P=Pharmacy
S=Medicare Supplemental

CAR-PHONE

X

10

Carrier Phone Number

DAT-REC-ADDED

X

8

Date record was added

LAST-MOD-DAT

X

8

Date record was last changed

LAST-MOD-TIME

X

8

Time record was last changed

LAST-MOD-USR

X

3

User who last modified record

CHG-RSN

X

2

Change reason

MASTER CARRIER ID

X

5

Master Carrier ID number from the Master Carrier reference file

INS-EMPR

X

30

Insured employer

CAR-STR-1

X

23

Carrier Address

CAR-STR-2

X

23

Carrier Address

CAR-CITY

X

18

Carrier Address City

CAR-ST

X

2

Carrier Address State

CAR-ZIP

X

9

Carrier Address Zip Code

DATE-VERIFIED

X

8

Date record was verified

ABS-PAR-IND

X

1

Verification Status
I=Invalid

SRC

X

2

Source of TPL referral

IRR

X

80

Invalid Record Reason (Text Message from PCG)

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BHS Monthly Third Party Liability File Layout

FIELD NAME

TYPE

SIZE

REMARKS

SEQUENCE NUMBER

U

2

TPL sequence number
Medicare data not included

PROCESSING DATE

X

6

YYMMDD

AHCCCS ID

X

9

Member's AHCCCS ID

LAST NAME

X

20

Member's Last Name

FIRST NAME

X

10

Member's First Name

GENDER

X

1

Member's Middle Initial

DATE OF BIRTH

X

8

Member's date of birth

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

END DATE

X

8

Policy End Date

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

INSURED EMPLOYER

X

30

Insured employer

INSURED GROUP NUMBER

X

20

Insured Group Number

DATE RECORD ADDED

X

8

Date record was added

DATE LAST MODIFIED

X

8

Date record was last changed

DATE VERIFIED

X

8

Date record was verified

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

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BHS Annual TPL File Layout

FIELD NAME

TYPE

SIZE

REMARKS

SEQ-NO

X

2

TPL sequence number

PROCESS-DAT

X

6

(YYMMDD) Processing date

AHCCCS-ID

X

9

Member’s AHCCCS ID

LAST-NAME

X

20

Member’s Last Name

FIRST-NAME

X

10

Member’s First Name

SEX

X

1

Member’s Middle Initial

DAT-OF-BIR

X

8

Member’s date of birth (CCYYMMDD)

POLICY-ID

X

20

Policy ID number or Medicare Claim number

INS-TYP

X

1

Insurance Type<br>M=Medical<br>P=Pharmacy<br>S=Medicare Supplemental

BEG-DAT

X

8

Policy Begin Date (CCYYMMDD)

END-DAT

X

8

Policy End Date (CCYYMMDD)

CAR-NAME

X

30

Carrier Name

CAR-PHONE

X

10

Carrier Phone Number

CAR-STR-1

X

23

Carrier Address

CAR-STR-2

X

23

Carrier Address

CAR-CITY

X

18

Carrier Address City

CAR-ST

X

2

Carrier Address State

CAR-ZIP

X

9

Carrier Address Zip Code

INSURED-NAME

X

31

Insured Name

INSURED-REL-PAT

X

1

Relationship to policy holder

INS-EMPR

X

30

Insured employer

INS-GRP-NUM

X

20

Insured Group Number

DAT-REC-ADDED

X

8

Date record was added

LAST-MOD-DAT

X

8

Date record was last changed

DATE-VERIFIED

X

8

Date record was verified

HP-ID (MEDICAL)

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

Text Message from PCG

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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

TRIBAL INDICATOR

X

1

Tribal Insurance Indicator (Y/N)

BEGIN DATE

X

8

Begin Date of record

END DATE

X

8

End Date of record

REC ADDED DATE

X

8

Date record originally added

REC ADDED TIME

X

8

Time record originally added

REC ADDED USER

X

3

User ID for record originally added

LAST MOD DATE

X

8

Date record last modified

LAST MOD TIME

X

8

Time record last modified

LAST MOD USER

X

3

User ID for record last modified

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