AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Daily Third Party Liability (TPL) Invalid 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)