AHCCCS Technical Interface Guidelines (TIG)

Behavioral Health Interface - Recipient Annual Third Party Liability (TPL) File Layout


FIELD NAME TYPE SIZE DESCRIPTION
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