AHCCCS Technical Interface Guidelines (TIG)

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


FIELD NAME TYPE SIZE DESCRIPTION
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 Reason Coverage Ended
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
STATUS X 1 Status of TPL Referral
I=Invalid
SRC X 2 Source of TPL referral
HP-ID X 6 Health Plan ID Number
IRR X 80 Invalid Record Reason (Text Message from PCG)