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AHCCCS Technical Interface Guidelines (TIG)

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

FIELD NAME TYPE SIZE DESCRIPTION
HEADER RECORD
Header Info X 6 "TPLHDR"
Processing Date X 8 (CCYYMMDD)
Filler X 396  
DETAIL RECORD
SEQ-NO X 2 TPL sequence number sequentially assigned, except for Medicare:
  • 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 Gender
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