AHCCCS Technical Interface Guidelines (TIG)

 

Health Plan Interface - Third Party Leads Submissions File Layout


FIELD NAME TYPE SIZE DESCRIPTION
HEADER RECORD
File Date X 8 (ccyymmdd) REQUIRED
Health Plan Id Number X 6 REQUIRED
Filler X 369  
DETAIL RECORD
Transaction Type X 1
  • A - Add
  • C - Change
  • T - Termination
REQUIRED
Activity Date X 8 (ccyymmdd) REQUIRED
Member Last Name X 17 REQUIRED
Member First Name X 12 REQUIRED
Member Middle Initial X 1  
Gender X 1 M=Male, F=Female
REQUIRED
Social Security No X 9  
AHCCCS ID X 10 REQUIRED
Date of Birth X 8 (ccyymmdd) REQUIRED
Date of Death X 8 (ccyymmdd)
Insured Relation to Client X 3 Relationship to policy holder
  • A-Absent Parent
  • C-Child
  • G-Guarantor
  • L-Legal Guardian
  • O-Other
  • P-Parent
  • S-Self
Carrier Name X 36 REQUIRED
Carrier Street 1 X 40  
Carrier Street 2 X 40  
Carrier City X 30  
Carrier State X 2  
Carrier ZIP X 9  
Carrier Phone X 10  
Policy Number X 20 REQUIRED if no Insured SSN
Group Number X 20  
Policy Begin Date X 8 (ccyymmdd)
Policy End Date X 8 (ccyymmdd)
Filler X 3  
Insured Last Name X 17 REQUIRED
Insured First Name X 12 REQUIRED
Insured Middle Initial X 1  
Insured SSN X 9 REQUIRED if no Policy Number
Insured Employer X 40  
TRAILER RECORD
Number of Records X 5 REQUIRED
Filler X 378