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AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - RF401 Rate Codes

1000's 2000's 3000's 4000's 5000's 6000's 7000's 8000's 9000's

1000's
CODE DESCRIPTION BEGIN DATE END DATE
100A TANF < 1 M & F WITH MEDICARE PPC 10/96  
100B TANF 01-05 M & F WITH MEDICARE PPC 10/96  
100C TANF 06-13 M & F WITH MEDICARE PPC 10/96  
100D TANF 14-20 MALE WITH MEDICARE PPC 10/96  
100E TANF 14-20 FEMALE WITH MEDICARE PPC 10/96  
100F TANF 21-44 MALE WITH MEDICARE PPC 10/96  
100G TANF 21-44 FEMALE WITH MEDICARE PPC 10/96  
100H TANF 44-64 M & F WITH MEDICARE PPC 10/96  
100J TANF 65+ M & F WITH MEDICARE PPC 10/96  
100Z TANF ALTCS WITH MEDICARE PPC 10/96  
1000 TANF WITH MEDICARE 10/82  
1001 TANF < 1 M & F WITH MEDICARE 10/97  
1002 TANF 01-05 M & F WITH MEDICARE 10/97  
1003 TANF 06-13 M & F WITH MEDICARE 10/97  
1004 TANF 14-20 MALE WITH MEDICARE 10/97  
1005 TANF 14-20 FEMALE WITH MEDICARE 10/97  
1006 TANF 21-44 MALE WITH MEDICARE 10/97  
1007 TANF 21-44 FEMALE WITH MEDICARE 10/97  
1008 TANF 45-64 M & F WITH MEDICARE 10/97  
1009 TANF 65+ M & F WITH MEDICARE 10/97  
101A TANF < 1 M & F NON-MEDICARE PPC 10/96  
101B TANF 01-05 M & F NON-MEDICARE PPC 10/96  
101C TANF 06-13 M & F NON-MEDICARE PPC 10/96  
101D TANF 14-20 MALE NON-MEDICARE PPC 10/96  
101E TANF 14-20 FEMALE NON-MEDICARE PPC 10/96  
101F TANF 21-44 MALE NON-MEDICARE PPC 10/96  
101G TANF 21-44 FEMALE NON-MEDICARE PPC 10/96  
101H TANF 44-64 M & F NON-MEDICARE PPC 10/96  
101J TANF 65+ N & F NON-MEDICARE PPC 10/96  
101Z TANF ALTCS NON-MEDICARE PPC 10/96  
1010 TANF NON-MEDICARE 10/82  
1011 TANF <1 M & F NON-MEDICARE 10/97  
1012 TANF 01-05 M & F NON-MEDICARE 10/97  
1013 TANF 06-13 M & F NON-MEDICARE 10/97  
1014 TANF 14-20 MALE NON-MEDICARE 10/97  
1015 TANF 14-20 FEMALE NON-MEDICARE 10/97  
1016 TANF 21-44 MALE NON-MEDICARE 10/97  
1017 TANF 21-44 FEMALE NON-MEDICARE 10/97  
1018 TANF 45-64 M & F NON-MEDICARE 10/97  
1019 TANF 65+ M & F NON-MEDICARE 10/97  
102A TANF < 1 M & F WITH QMB PPC 10/96  
102B TANF 01-05 M & F WITH QMB PPC 10/96  
102C TANF 06-13 M & F WITH QMB PPC 10/96  
102D TANF 14-20 MALE WITH QMB PPC 10/96  
102E TANF 14-20 FEMALE WITH QMB PPC 10/96  
102F TANF 21-44 MALE WITH QMB PPC 10/96  
102G TANF 21-44 FEMALE WITH QMB PPC 10/96  
102H TANF 44-64 M & F WITH QMB PPC 10/96  
102J TANF 65+ M & F WITH QMB PPC 10/96  
102Z TANF ALTCS WITH QMB PPC 10/96  
1020 TANF WITH QMB 01/89  
1021 TANF <1 M & F WITH QMB 10/97  
1022 TANF 01-05 M & F WITH QMB 10/97  
1023 TANF 06-13 M & F WITH QMB 10/97  
1024 TANF 14-20 MALE WITH QMB 10/97  
1025 TANF 14-20 FEMALE WITH QMB 10/97  
1026 TANF 21-44 MALE WITH QMB 10/97  
1027 TANF 21-44 FEMALE WITH QMB 10/97  
1028 TANF 45-64 M & F WITH QMB 10/97  
1029 TANF 65+ M & F WITH QMB 10/97  
110A TANF EXPANDED <1 M & F W/MDC PPC 04/01  
110B TANF EXPANDED 01-05 M & F W/MDC PPC 04/01  
110C TANF EXPANDED 06-13 M & F W/MDC PPC 04/01  
110D TANF EXPANDED 14-20 MALE W/MDC PPC 04/01  
110E TANF EXPANDED 14-20 FEMALE W/MDC PPC 04/01  
110F TANF EXPANDED 21-44 MALE W/MDC PPC 04/01  
110G TANF EXPANDED 21-44 FEMALE W/MDC PPC 04/01  
110H TANF EXPANDED 45-64 M & F W/MDC PPC 04/01  
110J TANF EXPANDED 65+ M & F W/MDC 04/01  
1101 TANF EXPANDED <1 M & F W/MDC 04/01  
1102 TANF EXPANDED 01-05 M & F W/MDC 04/01  
1103 TANF EXPANDED 06-13 M & F W/MDC 04/01  
1104 TANF EXPANDED 14-20 MALE W/MDC 04/01  
1105 TANF EXPANDED 14-20 FEMALE W/MDC 04/01  
1106 TANF EXPANDED 21-44 MALE W/MDC 04/01  
1107 TANF EXPANDED 21-44 FEMALE W/MDC 04/01  
1108 TANF EXPANDED 45-64 M & F W/MDC 04/01  
1109 TANF EXPANDED 65+ M & F W/MDC 04/01  
111A TANF EXPANDED <1 M & F NO MDC PPC 04/01  
111B TANF EXPANDED 01-05 M & F NO MDC PPC 04/01  
111C TANF EXPANDED 06-13 M & F NO MDC PPC 04/01  
111D TANF EXPANDED 14-20 MALE NO MDC PPC 04/01  
111E TANF EXPANDED 14-20 FEMALE NO MDC PPC 04/01  
111F TANF EXPANDED 21-44 MALE NO MDC PPC 04/01  
111G TANF EXPANDED 21-44 FEMALE NO MDC PPC 04/01  
111H TANF EXPANDED 45-64 M & F NO MDC PPC 04/01  
111J TANF EXPANDED 65+ M & F NO MDC PPC 04/01  
1111 TANF EXPANDED <1 M & F NO MDC 04/01  
1112 TANF EXPANDED 01-05 M & F NO MDC 04/01  
1113 TANF EXPANDED 06-13 M & F NO MDC 04/01  
1114 TANF EXPANDED 14-20 MALE NO MDC 04/01  
1115 TANF EXPANDED 14-20 FEMALE NO MDC 04/01  
1116 TANF EXPANDED 21-44 MALE NO MDC 04/01  
1117 TANF EXPANDED 21-44 FEMALE NO MDC 04/01  
1118 TANF EXPANDED 45-64 M & F NO MDC 04/01  
1119 TANF EXPANDED 65+ M & F NO MDC 04/01  
112A TANF EXPANDED <1 M & F W/QMB PPC 04/01  
112B TANF EXPANDED 01-05 M & F W/QMB PPC 04/01  
112C TANF EXPANDED 06-13 M & F W/QMB PPC 04/01  
112D TANF EXPANDED 14-20 MALE W/QMB PPC 04/01  
112E TANF EXPANDED 14-20 FEMALE W/QMB PPC 04/01  
112F TANF EXPANDED 21-44 MALE W/QMB PPC 04/01  
112G TANF EXPANDED 21-44 FEMALE W/QMB PPC 04/01  
112H TANF EXPANDED 45-64 M & F W/QMB PPC 04/01  
112J TANF EXPANDED 65+ M & F W/QMB PPC 04/01  
1121 TANF EXPANDED <1 M & F W/QMB 04/01  
1122 TANF EXPANDED 01-05 M & F W/QMB 04/01  
1123 TANF EXPANDED 06-13 M & F W/QMB 04/01  
1124 TANF EXPANDED 14-20 MALE W/QMB 04/01  
1125 TANF EXPANDED 14-20 FEMALE W/QMB 04/01  
1126 TANF EXPANDED 21-44 MALE W/QMB 04/01  
1127 TANF EXPANDED 21-44 FEMALE W/QMB 04/01  
1128 TANF EXPANDED 45-64 M & F W/QMB 04/01  
1129 TANF EXPANDED 65+ M & F W/QMB 04/01