AHCCCS Technical Interface Guidelines (TIG)

 

Health Plan Interface - Third Party Liability (TPL) Process


 

Introduction

The Third Party Liability (TPL) process identifies:

  • Verified TPL data received from and updated by our TPL contractor
  • Invalid TPL notifications

TPL referral data is received from many different sources including Health Plans, eligibility sources (DES, SSA, etc) and our TPL contractor. The referrals are processed through a validation process and we receive updates to the referrals that either verify TPL data or invalidate referrals. In addition to the TPL verifications, Medicare data is also provided on the daily files.

 

Schedules

  • The TPL file processing is performed seven days a week with the TPL Verification Contractor.
  • The Medicare data update process is performed on several different schedules including daily, semi-monthly, and monthly.
  • TPL Daily Verified data files are downloaded to the AHCCCS Communications Server, verified, and available for extraction by the BHS by 7:00 a.m. the next day. File is named yymmdd.TPL (daily file) and is available in the BHS folder under /AZ/BHS/PROD/OUT folder and will contain both TPL and Medicare data
  • TPL Daily Invalid Notification data file contains invalid TPL referrals that are downloaded to the AHCCCS Communications Server and are available for extraction by BHS by 7:00 a.m. the next day. File is named yymmdd.NOT (notification file) and is available in the BHS folder under /AZ/BHS/PROD/OUT folder
  • TPL Verified data Monthly file contains verified TPL data that are downloaded to the AHCCCS Communications Server based upon the membership as of the first of the month and available for extraction by the BHS. File is named ccyymm.TPL and is available in the BHS folder under /AZ/BHS/PROD/OUT folder and will contain only TPL data.
  • Master Carrier ID files are downloaded to the AHCCCS Communications Server each Friday and available for extraction by the BHS by 7:00 a.m. the next day. File is named RFCARIDmmddyy.TXT and is available in the ShareINFO folder under /AZ/ShareINFO/Reference/PROD/OUT folder.

 

Media

The TPL File is available on the AHCCCS communications server.

 

Testing

TPL file transmissions must be tested in coordination with AHCCCS ISD operations staff prior to production implementation of a new Health Plan or change in service bureau, or as a result of roster changes. Typical testing of transmissions takes approximately one week and must be completed prior to implementation of any new processing arrangement.

 

Reference Documents