AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Manual Payment Roster File Layout


DATA NAME PICTURE ACTUAL POSITIONS DESCRIPTION
FROM TO
RECORD TYPE X(02) 1 2 '01'=DETAIL, 'XX'=TRAILER
PROCESS DATE X(08) 3 10 CCYYMMDD
HEALTH PLAN ID X(06) 11 16  
CONTRACT TYPE X(01) 17 17 See Contract Type Codes
AHCCCS ID X(09) 18 26  
CASE ID X(09) 27 35  
PRIMARY AHCCCS ID X(09) 36 44  
ALTERNATE ID X(15) 45 59  
MEDICARE CLAIM ID X(12) 60 71  
PROCESS SEQUENCE X(02) 72 73 '01', '02', '03', ETC.
ACTION TYPE X(01) 74 74
  • A=ADD
  • C=CHANGE
  • D=DELETE/DISENROLL
GSA CODE X(02) 75 76 See County Codes
GSA DESCRIPTION X(15) 77 91  
COUNTY CODE X(02) 92 93 See County Codes
COUNTY NAME X(15) 94 108  
MEDICARE COVERAGE 'A' X(01) 109 109 'Y' or 'N'
MEDICARE COVERAGE 'B' X(01) 110 110 'Y' or 'N'
ACTION CODE X(02) 111 126 MAY OCCUR UP TO 8 TIMES (SEE ATTACHED AC TABLE)
RECIPIENT LAST NAME X(23) 127 149  
RECIPIENT FIRST NAME X(10) 150 159  
RECIPIENT M. INITIAL X(01) 160 160  
RECIPIENT GENDER X(01) 161 161 'M' or 'F'
DATE OF BIRTH X(08) 162 169 CCYYMMDD
DATE OF DEATH X(08) 170 177 CCYYMMDD
MAIL STREET ADDRESS 1 X(25) 178 202  
MAIL STREET ADDRESS 2 X(25) 203 227  
MAIL CITY X(20) 228 247  
MAIL STATE X(02) 248 249  
MAIL ZIP CODE 5 X(05) 250 254  
MAIL ZIP CODE 4 X(04) 255 258  
FILLER 1 X(05) 259 263  
RESIDENCE ST. ADD. 1 X(25) 264 288  
RESIDENCE ST. ADD. 2 X(25) 289 313  
RESIDENCE CITY X(20) 314 333  
RESIDENCE STATE X(02) 334 335  
RESIDENCE ZIP CODE 5 X(05) 336 340  
RESIDENCE ZIP CODE 4 X(04) 341 344  
FILLER 2 X(04) 345 348  
TELEPHONE NUMBER X(10) 349 358  
ELIGIBILITY BEGIN DATE X(08) 359 366 CCYYMMDD (MN/MI and ELIC ONLY)
ELIGIBILITY END DATE X(08) 367 374 CCYYMMDD (MN/MI and ELIC ONLY)
PPC/ENROLL BEGIN DATE X(08) 375 382 CCYYMMDD
PPC/ENROLL END DATE X(08) 383 390 CCYYMMDD
ENROLLMENT RATE CODE X(04) 391 394 Refer to "Rate Code Table"
FILLER 3 X(10) 395 404  
RISK GROUP X(04) 405 408
  • TACI=TANF M&F<1
  • FMAL=TANF 'F' 14 - 44
  • ADLT=TANF M & F 45+
  • SSIW=SSI W/MEDICARE
  • SFPS=SOBRA FPS
  • ALTC=TANF (LTC)
RISK GROUP QUALIFIER X(02) 409 410
  • AF=AFDC(NON-SOBRA)
  • EL=ELIC
  • KC=KIDSCARE
  • MN=MEDICALLY NEEDY
  • QB=QMB ONLY BLIND
  • SD=SSI DISABLED
  • SO=SOBRA WOMAN
FILLER 4 X(08) 411 418  
VOUCHER NUMBER X(09) 419 427  
CAPITATION AMOUNT N(7.2) 428 436  
NUMBER DAYS COVERED X(03) 437 439  
PAYMENT FROM DATE X(08) 440 447 CCYYMMDD
PAYMENT THRU DATE X(08) 448 455 CCYYMMDD
PREGNANCY INDICATOR X(01) 456 456 'Y' or BLANK
LTC TRANSITION IND. X(01) 457 457 'T' or BLANK
FACILITY ID X(06) 458 463 ALTCS from LEDS
FACILITY NAME X(25) 464 488 ALTCS from LEDS
SHARE OF COST DATE X(06) 489 524 MMCCYY - OCCURS 6 TIMES (ALTCS ONLY)
SHARE OF COST AMOUNT N(6.2) 525 572 OCCURS 6 TIMES (ALTCS ONLY)
PRIOR PLAN INDICATOR X(01) 573 573 'Y' or BLANK
PRIOR PLAN NAME X(25) 574 598  
MENTAL HEALTH CAT. X(01) 599 599
  • C=CHILDRENS SVCS
  • I=NON-SMI 18-20 & 65+
  • S=SMI, H=GMH AL/SUBS. SVCS
  • K=KC CHILDREN 18 - 19
  • Z=SED CHILDREN
FILLER 5 X(02) 600 601  
MENTAL HLTH BEGIN DT X(08) 602 609 CCYYMMDD
MENTAL HEALTH END DT X(08) 610 617 CCYYMMDD
FILLER 6 X(83) 618 700  
THE LAST RECORD OF EACH DISK FILE HAS THE FOLLOWING SPECIFICATIONS:
RECORD TYPE X(02) 1 2 'XX'
PROCESS DATE X(08) 3 10 CCYYMMDD
HEALTH PLAN ID X(06) 11 16  
NUMBER OF RECIPIENTS X(08) 17 24  
TOTAL CAP AMOUNT N(9.2) 25 35  
FILLER X(665) 36 700