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