AHCCCS Technical Interface Guidelines (TIG)

Health Plan Interface - Monthly Third Party Liability (TPL) Verified Data File Layout


FIELD NAME TYPE SIZE DESCRIPTION
SEQUENCE NUMBER U 2 TPL sequence number
Medicare data not included
PROCESSING DATE X 6 YYMMDD
AHCCCS ID X 9 Member's AHCCCS ID
LAST NAME X 20 Member's Last Name
FIRST NAME X 10 Member's First Name
SEX X 1 Member's Gender
DATE OF BIRTH X 8 Member's date of birth
POLICY ID X 20 Policy ID number
INSURANCE TYPE X 1 Insurance Type:
  • M=Medical
  • P=Pharmacy
  • S=Medicare Supplemental
BEGIN DATE X 8 Policy Begin Date
END DATE X 8 Policy End Date
CARRIER NAME X 30 Carrier Name
CARRIER PHONE X 10 Carrier Phone Number
CARRIER STREET ADDRESS 1 X 23 Carrier Address)
CARRIER STREET ADDRESS 2 X 23 Carrier Address
CARRIER CITY X 18 Carrier Address City
CARRIER STATE X 2 Carrier Address State
CARRIER ZIP CODE X 9 Carrier Address Zip Code
INSURED NAME X 31 Insured Name
INSURED & PATIENT RELATIONSHIP X 1 Relationship to policy holder:
  • A - Absent Parent
  • C - Child
  • G - Guarantor
  • L - Legal Guardian
  • O - Other
  • P - Parent
  • S - Self
INSURED EMPLOYER X 30 Insured employer
INSURED GROUP NUMBER X 20 Insured Group Number
DATE RECORD ADDED X 8 Date record was added
DATE LAST MODIFIED X 8 Date record was last changed
DATE VERIFIED X 8 Date record was verified
HEALTH PLAN ID X 6 HP ID number
FILLER X 5 (To be used for future expansion of the Master Carrier ID)
MASTER CARRIER ID X 5 Master Carrier ID number from the Master Carrier reference file
IRR X 80 Field not used