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