AHCCCS Technical Interface Guidelines (TIG) - Health Plan Interface - Codes

1000's

CODE DESCRIPTION BEGIN DATE END DATE
100A TANF < 1 M & F WITH MEDICARE PPC 10/96  
100B TANF 01-05 M & F WITH MEDICARE PPC 10/96  
100C TANF 06-13 M & F WITH MEDICARE PPC 10/96  
100D TANF 14-20 MALE WITH MEDICARE PPC 10/96  
100E TANF 14-20 FEMALE WITH MEDICARE PPC 10/96  
100F TANF 21-44 MALE WITH MEDICARE PPC 10/96  
100G TANF 21-44 FEMALE WITH MEDICARE PPC 10/96  
100H TANF 44-64 M & F WITH MEDICARE PPC 10/96  
100J TANF 65+ M & F WITH MEDICARE PPC 10/96  
100Z TANF ALTCS WITH MEDICARE PPC 10/96  
1000 TANF WITH MEDICARE 10/82  
1001 TANF < 1 M & F WITH MEDICARE 10/97  
1002 TANF 01-05 M & F WITH MEDICARE 10/97  
1003 TANF 06-13 M & F WITH MEDICARE 10/97  
1004 TANF 14-20 MALE WITH MEDICARE 10/97  
1005 TANF 14-20 FEMALE WITH MEDICARE 10/97  
1006 TANF 21-44 MALE WITH MEDICARE 10/97  
1007 TANF 21-44 FEMALE WITH MEDICARE 10/97  
1008 TANF 45-64 M & F WITH MEDICARE 10/97  
1009 TANF 65+ M & F WITH MEDICARE 10/97  
101A TANF < 1 M & F NON-MEDICARE PPC 10/96  
101B TANF 01-05 M & F NON-MEDICARE PPC 10/96  
101C TANF 06-13 M & F NON-MEDICARE PPC 10/96  
101D TANF 14-20 MALE NON-MEDICARE PPC 10/96  
101E TANF 14-20 FEMALE NON-MEDICARE PPC 10/96  
101F TANF 21-44 MALE NON-MEDICARE PPC 10/96  
101G TANF 21-44 FEMALE NON-MEDICARE PPC 10/96  
101H TANF 44-64 M & F NON-MEDICARE PPC 10/96  
101J TANF 65+ N & F NON-MEDICARE PPC 10/96  
101Z TANF ALTCS NON-MEDICARE PPC 10/96  
1010 TANF NON-MEDICARE 10/82  
1011 TANF <1 M & F NON-MEDICARE 10/97  
1012 TANF 01-05 M & F NON-MEDICARE 10/97  
1013 TANF 06-13 M & F NON-MEDICARE 10/97  
1014 TANF 14-20 MALE NON-MEDICARE 10/97  
1015 TANF 14-20 FEMALE NON-MEDICARE 10/97  
1016 TANF 21-44 MALE NON-MEDICARE 10/97  
1017 TANF 21-44 FEMALE NON-MEDICARE 10/97  
1018 TANF 45-64 M & F NON-MEDICARE 10/97  
1019 TANF 65+ M & F NON-MEDICARE 10/97  
102A TANF < 1 M & F WITH QMB PPC 10/96  
102B TANF 01-05 M & F WITH QMB PPC 10/96  
102C TANF 06-13 M & F WITH QMB PPC 10/96  
102D TANF 14-20 MALE WITH QMB PPC 10/96  
102E TANF 14-20 FEMALE WITH QMB PPC 10/96  
102F TANF 21-44 MALE WITH QMB PPC 10/96  
102G TANF 21-44 FEMALE WITH QMB PPC 10/96  
102H TANF 44-64 M & F WITH QMB PPC 10/96  
102J TANF 65+ M & F WITH QMB PPC 10/96  
102Z TANF ALTCS WITH QMB PPC 10/96  
1020 TANF WITH QMB 01/89  
1021 TANF <1 M & F WITH QMB 10/97  
1022 TANF 01-05 M & F WITH QMB 10/97  
1023 TANF 06-13 M & F WITH QMB 10/97  
1024 TANF 14-20 MALE WITH QMB 10/97  
1025 TANF 14-20 FEMALE WITH QMB 10/97  
1026 TANF 21-44 MALE WITH QMB 10/97  
1027 TANF 21-44 FEMALE WITH QMB 10/97  
1028 TANF 45-64 M & F WITH QMB 10/97  
1029 TANF 65+ M & F WITH QMB 10/97  
110A TANF EXPANDED <1 M & F W/MDC PPC 04/01  
110B TANF EXPANDED 01-05 M & F W/MDC PPC 04/01  
110C TANF EXPANDED 06-13 M & F W/MDC PPC 04/01  
110D TANF EXPANDED 14-20 MALE W/MDC PPC 04/01  
110E TANF EXPANDED 14-20 FEMALE W/MDC PPC 04/01  
110F TANF EXPANDED 21-44 MALE W/MDC PPC 04/01  
110G TANF EXPANDED 21-44 FEMALE W/MDC PPC 04/01  
110H TANF EXPANDED 45-64 M & F W/MDC PPC 04/01  
110J TANF EXPANDED 65+ M & F W/MDC 04/01  
1101 TANF EXPANDED <1 M & F W/MDC 04/01  
1102 TANF EXPANDED 01-05 M & F W/MDC 04/01  
1103 TANF EXPANDED 06-13 M & F W/MDC 04/01  
1104 TANF EXPANDED 14-20 MALE W/MDC 04/01  
1105 TANF EXPANDED 14-20 FEMALE W/MDC 04/01  
1106 TANF EXPANDED 21-44 MALE W/MDC 04/01  
1107 TANF EXPANDED 21-44 FEMALE W/MDC 04/01  
1108 TANF EXPANDED 45-64 M & F W/MDC 04/01  
1109 TANF EXPANDED 65+ M & F W/MDC 04/01  
111A TANF EXPANDED <1 M & F NO MDC PPC 04/01  
111B TANF EXPANDED 01-05 M & F NO MDC PPC 04/01  
111C TANF EXPANDED 06-13 M & F NO MDC PPC 04/01  
111D TANF EXPANDED 14-20 MALE NO MDC PPC 04/01  
111E TANF EXPANDED 14-20 FEMALE NO MDC PPC 04/01  
111F TANF EXPANDED 21-44 MALE NO MDC PPC 04/01  
111G TANF EXPANDED 21-44 FEMALE NO MDC PPC 04/01  
111H TANF EXPANDED 45-64 M & F NO MDC PPC 04/01  
111J TANF EXPANDED 65+ M & F NO MDC PPC 04/01  
1111 TANF EXPANDED <1 M & F NO MDC 04/01  
1112 TANF EXPANDED 01-05 M & F NO MDC 04/01  
1113 TANF EXPANDED 06-13 M & F NO MDC 04/01  
1114 TANF EXPANDED 14-20 MALE NO MDC 04/01  
1115 TANF EXPANDED 14-20 FEMALE NO MDC 04/01  
1116 TANF EXPANDED 21-44 MALE NO MDC 04/01  
1117 TANF EXPANDED 21-44 FEMALE NO MDC 04/01  
1118 TANF EXPANDED 45-64 M & F NO MDC 04/01  
1119 TANF EXPANDED 65+ M & F NO MDC 04/01  
112A TANF EXPANDED <1 M & F W/QMB PPC 04/01  
112B TANF EXPANDED 01-05 M & F W/QMB PPC 04/01  
112C TANF EXPANDED 06-13 M & F W/QMB PPC 04/01  
112D TANF EXPANDED 14-20 MALE W/QMB PPC 04/01  
112E TANF EXPANDED 14-20 FEMALE W/QMB PPC 04/01  
112F TANF EXPANDED 21-44 MALE W/QMB PPC 04/01  
112G TANF EXPANDED 21-44 FEMALE W/QMB PPC 04/01  
112H TANF EXPANDED 45-64 M & F W/QMB PPC 04/01  
112J TANF EXPANDED 65+ M & F W/QMB PPC 04/01  
1121 TANF EXPANDED <1 M & F W/QMB 04/01  
1122 TANF EXPANDED 01-05 M & F W/QMB 04/01  
1123 TANF EXPANDED 06-13 M & F W/QMB 04/01  
1124 TANF EXPANDED 14-20 MALE W/QMB 04/01  
1125 TANF EXPANDED 14-20 FEMALE W/QMB 04/01  
1126 TANF EXPANDED 21-44 MALE W/QMB 04/01  
1127 TANF EXPANDED 21-44 FEMALE W/QMB 04/01  
1128 TANF EXPANDED 45-64 M & F W/QMB 04/01  
1129 TANF EXPANDED 65+ M & F W/QMB 04/01  

2000's

CODE DESCRIPTION BEGIN DATE END DATE
210Z SSI AGED WITH MEDICARE PPC 10/96  
2100 SSI AGED WITH MEDICARE 10/82  
211Z SSI AGED NON-MEDICARE PPC 10/96  
2110 SSI AGED NON-MEDICARE 10/82  
212Z SSI AGED WITH QMB PPC 10/96  
2120 SSI AGED WITH QMB 01/89  
220Z SSI DISABLED WITH MEDICARE PPC 10/96  
2200 SSI DISABLED WITH MEDICARE 10/82  
221Z SSI DISABLED NON-MEDICARE PPC 10/96  
2210 SSI DISABLED NON-MEDICARE 10/82  
222Z SSI DISABLED WITH QMB PPC 10/96  
2220 SSI DISABLED WITH QMB 01/89  
230Z SSI BLIND WITH MEDICARE PPC 10/96  
2300 SSI BLIND WITH MEDICARE 10/82  
231Z SSI BLIND NON-MEDICARE PPC 10/96  
2310 SSI BLIND NON-MEDICARE 10/82  
232Z SSI BLIND WITH QMB PPC 10/96  
2320 SSI BLIND WITH QMB 01/89  
240Z SSI AGED EXPANDED WITH MEDICARE PPC 04/01  
2400 SSI AGED EXPANDED WITH MEDICARE 04/01  
241Z SSI AGED EXPANDED NO MDC PPC 04/01  
2410 SSI AGED EXPANDED NO MDC 04/01  
242Z SSI AGED EXPANDED WITH QMB PPC 04/01  
2420 SSI AGED EXPANDED WITH QMB 04/01  
250Z SSI BLIND EXPANDED WITH MEDICARE PPC 04/01  
2500 SSI BLIND EXPANDED WITH MEDICARE 04/01  
251Z SSI BLIND EXPANDED NO MDC PPC 04/01  
2510 SSI BLIND EXPANDED NO MDC 04/01  
252Z SSI BLIND EXPANDED WITH QMB PPC 04/01  
2520 SSI BLIND EXPANDED WITH QMB 04/01  
260Z SSI DISABLED EXPANDED WITH MDC PPC 04/01  
2600 SSI DISABLED EXPANDED WITH MDC 04/01  
261Z SSI DISABLED EXPANDED NON-MDC PPC 04/01  
2610 SSI DISABLED EXPANDED NON-MDC 04/01  
262Z SSI DISABLED EXPANDED WITH QMB PPC 04/01  
2620 SSI DISABLED EXPANDED WITH QMB 04/01  

3000's

CODE DESCRIPTION BEGIN DATE END DATE
300Z MN/MI WITH MEDICARE PPC 10/96  
3000 MN/MI WITH MEDICARE 10/82  
301Z MN/MI NON-MEDICARE PPC 10/96  
3010 MN/MI NON-MEDICARE 10/82  
330A AHC CARE M & F <1 W/MDC PPC 10/01  
330B AHC CARE M & F 01-05 W/MDC PPC 10/01  
330C AHC CARE M & F 06-13 W/MDC PPC 10/01  
330D AHC CARE MALE 14-20 W/MDC PPC 10/01  
330E AHC CARE FEMALE 14-20 W/MDC PPC 10/01  
330F AHC CARE MALE 21-44 W/MDC PPC 10/01  
330G AHC CARE FEMALE 21-44 W/MDC PPC 10/01  
330H AHC CARE M & F 45-64 W/MDC PPC 10/01  
330J AHC CARE M & F 65+ W/MDC PPC 10/01  
3301 AHC CARE M & F <1 W/MDC 10/01  
3302 AHC CARE M & F 01-05 W/MDC 10/01  
3303 AHC CARE M & F 06-13 W/MDC 10/01  
3304 AHC CARE MALE 14-20 W/MDC 10/01  
3305 AHC CARE FEMALE 14-20 W/MDC 10/01  
3306 AHC CARE MALE 21-44 W/MDC 10/01  
3307 AHC CARE FEMALE 21-44 W/MDC 10/01  
3308 AHC CARE M & F 45-64 W/MDC 10/01  
3309 AHC CARE M & F 65+ W/MDC 10/01  
331A AHC CARE M & F <1 NO-MED PPC 10/01  
331B AHC CARE M & F 01-05 NO-MED PPC 10/01  
331C AHC CARE M & F 06-13 NO-MED PPC 10/01  
331D AHC CARE MALE 14-20 NO-MED PPC 10/01  
331E AHC CARE FEMALE 14-20 NO-MED PPC 10/01  
331F AHC CARE MALE 21-44 NO-MED PPC 10/01  
331G AHC CARE FEMALE 21-44 NO-MED PPC 10/01  
331H AHC CARE M & F 45-64 NO-MED PPC 10/01  
331J AHC CARE M & F 65+ NO-MED PPC 10/01  
3311 AHC CARE M & F <1 NO-MED 10/01  
3312 AHC CARE M & F 01-05 NO-MED 10/01  
3313 AHC CARE M & F 06-13 NO-MED 10/01  
3314 AHC CARE MALE 14-20 NO-MED 10/01  
3315 AHC CARE FEMALE 14-20 NO-MED 10/01  
3316 AHC CARE MALE 21-44 NO-MED 10/01  
3317 AHC CARE FEMALE 21-44 NO-MED 10/01  
3318 AHC CARE M & F 45-64 NO-MED 10/01  
3319 AHC CARE M & F 65+ NO-MED 10/01  
332A AHC CARE M & F <1 W/QMB PPC 10/01  
332B AHC CARE M & F 01-05 W/QMB PPC 10/01  
332C AHC CARE M & F 06-13 W/QMB PPC 10/01  
332D AHC CARE MALE 14-20 W/QMB PPC 10/01  
332E AHC CARE FEMALE 14-20 W/QMB PPC 10/01  
332F AHC CARE MALE 21-44 W/QMB PPC 10/01  
332G AHC CARE FEMALE 21-44 W/QMB PPC 10/01  
332H AHC CARE M & F 45-64 W/QMB PPC 10/01  
332J AHC CARE M & F 65+ W/QMB PPC 10/01  
3321 AHC CARE M & F <1 W/QMB 10/01  
3322 AHC CARE M & F 01-05 W/QMB 10/01  
3323 AHC CARE M & F 06-13 W/QMB 10/01  
3324 AHC CARE MALE 14-20 W/QMB 10/01  
3325 AHC CARE FEMALE 14-20 W/QMB 10/01  
3326 AHC CARE MALE 21-44 W/QMB 10/01  
3327 AHC CARE FEMALE 21-44 W/QMB 10/01  
3328 AHC CARE M & F 45-64 W/QMB 10/01  
3329 AHC CARE M & F 65+ W/QMB 10/01  
340Z MED ELIGIBILITY W/MDC PPC 04/01  
3400 MED ELIGIBILITY W/MDC 04/01  
341Z MED ELIGIBILITY NON-MDC PPC 04/01  
3410 MED ELIGIBILITY NON-MDC 04/01  
342Z MED ELIGIBILITY W/QMB PPC 04/01  
3420 MED ELIGIBILITY W/QMB 04/01  
350A AHC CARE HOSP M & F <1 W/MDC PPC 10/01  
350B AHC CARE HOSP M & F 01-05 W/MDC PPC 10/01  
350C AHC CARE HOSP M & F 06-13 W/MDC PPC 10/01  
350D AHC CARE HOSP MALE 14-20 W/MDC PPC 10/01  
350E AHC CARE HOSP FEMALE 14-20 W/MDC PPC 10/01  
350F AHC CARE HOSP MALE 21-44 W/MDC PPC 10/01  
350G AHC CARE HOSP FEMALE 21-44 W/MDC PPC 10/01  
350H AHC CARE HOSP M & F 45-64 W/MDC PPC 10/01  
350J AHC CARE HOSP M & F 65+ W/MDC PPC 10/01  
3501 AHC CARE HOSP M & F <1 W/MDC 10/01  
3502 AHC CARE HOSP M & F 01-05 W/MDC 10/01  
3503 AHC CARE HOSP M & F 06-13 W/MDC 10/01  
3504 AHC CARE HOSP MALE 14-20 W/MDC 10/01  
3505 AHC CARE HOSP FEMALE 14-20 W/MDC 10/01  
3506 AHC CARE HOSP MALE 21-44 W/MDC 10/01  
3507 AHC CARE HOSP FEMALE 21-44 W/MDC 10/01  
3508 AHC CARE HOSP M & F 45-64 W/MDC 10/01  
3509 AHC CARE HOSP M & F 65+ W/MDC 10/01  
351A AHC CARE HOSP M & F <1 NO-MED PPC 10/01  
351B AHC CARE HOSP M & F 01-05 NO-MED PPC 10/01  
351C AHC CARE HOSP M & F 06-13 NO-MED PPC 10/01  
351D AHC CARE HOSP MALE 14-20 NO-MED PPC 10/01  
351E AHC CARE HOSP FEMALE 14-20 NO-MED PPC 10/01  
351F AHC CARE HOSP MALE 21-44 NO-MED PPC 10/01  
351G AHC CARE HOSP FEMALE 21-44 NO-MED PPC 10/01  
351H AHC CARE HOSP M & F 45-64 NO-MED PPC 10/01  
351J AHC CARE HOSP M & F 65+ NO-MED PPC 10/01  
3511 AHC CARE HOSP M & F <1 NO-MED 10/01  
3512 AHC CARE HOSP M & F 01-05 NO-MED 10/01  
3513 AHC CARE HOSP M & F 06-13 NO-MED 10/01  
3514 AHC CARE HOSP MALE 14-20 NO-MED 10/01  
3515 AHC CARE HOSP FEMALE 14-20 NO-MED 10/01  
3516 AHC CARE HOSP MALE 21-44 NO-MED 10/01  
3517 AHC CARE HOSP FEMALE 21-44 NO-MED 10/01  
3518 AHC CARE HOSP M & F 45-64 NO-MED 10/01  
3519 AHC CARE HOSP M & F 65+ NO-MED 10/01  
352A AHC CARE HOSP M & F <1 W/QMB PPC 10/01  
352A AHC CARE HOSP M & F 01-05 W/QMB PPC 10/01  
352C AHC CARE HOSP M & F 06-13 W/QMB PPC 10/01  
352D AHC CARE HOSP MALE 14-20 W/QMB PPC 10/01  
352E AHC CARE HOSP FEMALE 14-20 W/QMB PPC 10/01  
352F AHC CARE HOSP MALE 21-44 W/QMB PPC 10/01  
352G AHC CARE HOSP FEMALE 21-44 W/QMB PPC 10/01  
352H AHC CARE HOSP M & F 45-64 W/QMB PPC 10/01  
352J AHC CARE HOSP M & F 65+ W/QMB PPC 10/01  
3521 AHC CARE HOSP M & F <1 W/QMB 10/01  
3522 AHC CARE HOSP M & F 01-05 W/QMB 10/01  
3523 AHC CARE HOSP M & F 06-13 W/QMB 10/01  
3524 AHC CARE HOSP MALE 14-20 W/QMB 10/01  
3525 AHC CARE HOSP FEMALE 14-20 W/QMB 10/01  
3526 AHC CARE HOSP MALE 21-44 W/QMB 10/01  
3527 AHC CARE HOSP FEMALE 21-44 W/QMB 10/01  
3528 AHC CARE HOSP M & F 45-64 W/QMB 10/01  
3529 AHC CARE HOSP M & F 65+ W/QMB 10/01  
360A AHC CARE/MI M & F <1 W/MDC PPC 04/01  
360B AHC CARE/MI M & F 01-05 W/MDC PPC 04/01  
360C AHC CARE/MI M & F 06-13 W/MDC PPC 04/01  
360D AHC CARE/MI MALE 14-20 W/MDC PPC 04/01  
360E AHC CARE/MI FEMALE 14-20 W/MDC PPC 04/01  
360F AHC CARE/MI MALE 21-44 W/MDC PPC 04/01  
360G AHC CARE/MI FEMALE 21-44 W/MDC PPC 04/01  
360H AHC CARE/MI M & F 45-64 W/MDC PPC 04/01  
360J AHC CARE/MI M & F 65+ W/MDC PPC 04/01  
3601 AHC CARE/MI M & F <1 W/MDC 04/01  
3602 AHC CARE/MI M & F 01-05 W/MDC 04/01  
3603 AHC CARE/MI M & F 06-13 W/MDC 04/01  
3604 AHC CARE/MI MALE 14-20 W/MDC 04/01  
3605 AHC CARE/MI FEMALE 14-20 W/MDC 04/01  
3606 AHC CARE/MI MALE 21-44 W/MDC 04/01  
3607 AHC CARE/MI FEMALE 21-44 W/MDC 04/01  
3608 AHC CARE/MI M & F 45-64 W/MDC 04/01  
3609 AHC CARE/MI M & F 65+ W/MDC 04/01  
361A AHC CARE/MI M & F <1 NO-MED PPC 04/01  
361B AHC CARE/MI M & F 01-05 NO-MED PPC 04/01  
361C AHC CARE/MI M & F 06-13 NO-MED PPC 04/01  
361D AHC CARE/MI MALE 14-20 NO-MED PPC 04/01  
361E AHC CARE/MI FEMALE 14-20 NO-MED PPC 04/01  
361F AHC CARE/MI MALE 21-44 NO-MED PPC 04/01  
361G AHC CARE/MI FEMALE 21-44 NO-MED PPC 04/01  
361H AHC CARE/MI M & F 45-64 NO-MED PPC 04/01  
361J AHC CARE/MI M & F 65+ NO-MED PPC 04/01  
3611 AHC CARE/MI M & F <1 NO-MED 04/01  
3612 AHC CARE/MI M & F 01-05 NO-MED 04/01  
3613 AHC CARE/MI M & F 06-13 NO-MED 04/01  
3614 AHC CARE/MI MALE 14-20 NO-MED 04/01  
3615 AHC CARE/MI FEMALE 14-20 NO-MED 04/01  
3616 AHC CARE/MI MALE 21-44 NO-MED 04/01  
3617 AHC CARE/MI FEMALE 21-44 NO-MED 04/01  
3618 AHC CARE/MI M & F 45-64 NO-MED 04/01  
3619 AHC CARE/MI M & F 65+ NO-MED 04/01  
362A AHC CARE/MI M & F <1 W/QMB PPC 04/01  
362B AHC CARE/MI M & F 01-05 W/QMB PPC 04/01  
362C AHC CARE/MI M & F 06-13 W/QMB PPC 04/01  
362D AHC CARE/MI MALE 14-20 W/QMB PPC 04/01  
362E AHC CARE/MI FEMALE 14-20 W/QMB PPC 04/01  
362F AHC CARE/MI MALE 21-44 W/QMB PPC 04/01  
362G AHC CARE/MI FEMALE 21-44 W/QMB PPC 04/01  
362H AHC CARE/MI M & F 45-64 W/QMB PPC 04/01  
362J AHC CARE/MI M & F 65+ W/QMB PPC 04/01  
3621 AHC CARE/MI M & F <1 W/QMB 04/01  
3622 AHC CARE/MI M & F 01-05 W/QMB 04/01  
3623 AHC CARE/MI M & F 06-13 W/QMB 04/01  
3624 AHC CARE/MI MALE 14-20 W/QMB 04/01  
3625 AHC CARE/MI FEMALE 14-20 W/QMB 04/01  
3626 AHC CARE/MI MALE 21-44 W/QMB 04/01  
3627 AHC CARE/MI FEMALE 21-44 W/QMB 04/01  
3628 AHC CARE/MI M & F 45-64 W/QMB 04/01  
3629 AHC CARE/MI M & F 65+ W/QMB 04/01  
370A AHC CARE/MI HOSP M & F <1 W/MDC PPC 10/01  
370B AHC CARE/MI HOSP M & F 01-05 W/MDC PPC 10/01  
370C AHC CARE/MI HOSP M & F 06-13 W/MDC PPC 10/01  
370D AHC CARE/MI HOSP MALE 14-20 W/MDC PPC 10/01  
370E AHC CARE/MI HOSP FEMALE 14-20 W/MDC PPC 10/01  
370F AHC CARE/MI HOSP MALE 21-44 W/MDC PPC 10/01  
370G AHC CARE/MI HOSP FEMALE 21-44 W/MDC PPC 10/01  
370H AHC CARE/MI HOSP M & F 45-64 W/MDC PPC 10/01  
370J AHC CARE/MI HOSP M & F 65+ W/MDC PPC 10/01  
3701 AHC CARE/MI HOSP M & F <1 W/MDC 10/01  
3702 AHC CARE/MI HOSP M & F 01-05 W/MDC 10/01  
3703 AHC CARE/MI HOSP M & F 06-13 W/MDC 10/01  
3704 AHC CARE/MI HOSP MALE 14-20 W/MDC 10/01  
3705 AHC CARE/MI HOSP FEMALE 14-20 W/MDC 10/01  
3706 AHC CARE/MI HOSP MALE 21-44 W/MDC 10/01  
3707 AHC CARE/MI HOSP FEMALE 21-44 W/MDC 10/01  
3708 AHC CARE/MI HOSP M & F 45-64 W/MDC 10/01  
3709 AHC CARE/MI HOSP M & F 65+ W/MDC 10/01  
371A AHC CARE/MI HOSP M & F <1 NO-MED PPC 10/01  
371B AHC CARE/MI HOSP M & F 01-05 NO-MED PPC 10/01  
371C AHC CARE/MI HOSP M & F 06-13 NO-MED PPC 10/01  
371D AHC CARE/MI HOSP MALE 14-20 NO-MED PPC 10/01  
371E AHC CARE/MI HOSP FEMALE 14-20 NO-MED PPC 10/01  
371F AHC CARE/MI HOSP MALE 21-44 NO-MED PPC 10/01  
371G AHC CARE/MI HOSP FEMALE 21-44 NO-MED PPC 10/01  
371H AHC CARE/MI HOSP M & F 45-64 NO-MED PPC 10/01  
371J AHC CARE/MI HOSP M & F 65+ NO-MED PPC 10/01  
3711 AHC CARE/MI HOSP M & F <1 NO-MED 10/01  
3712 AHC CARE/MI HOSP M & F 01-05 NO-MED 10/01  
3713 AHC CARE/MI HOSP M & F 06-13 NO-MED 10/01  
3714 AHC CARE/MI HOSP MALE 14-20 NO-MED 10/01  
3715 AHC CARE/MI HOSP FEMALE 14-20 NO-MED 10/01  
3716 AHC CARE/MI HOSP MALE 21-44 NO-MED 10/01  
3717 AHC CARE/MI HOSP FEMALE 21-44 NO-MED 10/01  
3718 AHC CARE/MI HOSP M & F 45-64 NO-MED 10/01  
3719 AHC CARE/MI HOSP M & F 65+ NO-MED 10/01  
372A AHC CARE/MI HOSP M & F <1 W/QMB PPC 10/01  
372B AHC CARE/MI HOSP M & F 01-05 W/QMB PPC 10/01  
372C AHC CARE/MI HOSP M & F 06-13 W/QMB PPC 10/01  
372D AHC CARE/MI HOSP MALE 14-20 W/QMB PPC 10/01  
372E AHC CARE/MI HOSP FEMALE 14-20 W/QMB PPC 10/01  
372F AHC CARE/MI HOSP MALE 21-44 W/QMB PPC 10/01  
372G AHC CARE/MI HOSP FEMALE 21-44 W/QMB PPC 10/01  
372H AHC CARE/MI HOSP M & F 45-64 W/QMB PPC 10/01  
372J AHC CARE/MI HOSP M & F 65+ W/QMB PPC 10/01  
3721 AHC CARE/MI HOSP M & F <1 W/QMB 10/01  
3722 AHC CARE/MI HOSP M & F 01-05 W/QMB 10/01  
3723 AHC CARE/MI HOSP M & F 06-13 W/QMB 10/01  
3724 AHC CARE/MI HOSP MALE 14-20 W/QMB 10/01  
3725 AHC CARE/MI HOSP FEMALE 14-20 W/QMB 10/01  
3726 AHC CARE/MI HOSP MALE 21-44 W/QMB 10/01  
3727 AHC CARE/MI HOSP FEMALE 21-44 W/QMB 10/01  
3728 AHC CARE/MI HOSP M & F 45-64 W/QMB 10/01  
3729 AHC CARE/MI HOSP M & F 65+ W/QMB 10/01  
380Z MED HOSPITALIZED W/MDC PPC 10/01  
3800 MED HOSPITALIZED W/MDC 10/01  
381Z MED HOSPITALIZED NON-MDC PPC 10/01  
3810 MED HOSPITALIZED NON-MDC 10/01  
382Z MED HOSPITALIZED W/QMB PPC 10/01  
3820 MED HOSPITALIZED W/MDC 10/01  

4000's

CODE DESCRIPTION BEGIN DATE END DATE
410A EAC < 1 M & F WITH MEDICARE PPC 10/96  
410B EAC 01-05 M & F WITH MEDICARE PPC 10/96  
410C EAC 06-13 M & F WITH MEDICARE PPC 10/96  
410D EAC 14-20 MALE WITH MEDICARE PPC 10/96  
410E EAC 14-20 FEMALE WITH MEDICARE PPC 10/96  
4100 EAC WITH MEDICARE 01/87 09/97
4101 EAC <1 M & F WITH MEDICARE 10/97  
4102 EAC 01-05 M & F WITH MEDICARE 10/97  
4103 EAC 06-13 M & F WITH MEDICARE 10/97  
4104 EAC 14-20 MALE WITH MEDICARE 10/96  
4105 EAC 14-20 FEMALE WITH MEDICARE 10/96  
411A EAC < 1 M & F NON-MEDICARE PPC 10/96  
411B EAC 01-05 M & F NON-MEDICARE PPC 10/96  
411C EAC 06-13 M & F NON-MEDICARE PPC 10/96  
411D EAC 14-20 MALE NON-MEDICARE PPC 10/96  
411E EAC 14-20 FEMALE NON-MEDICARE PPC 10/96  
4110 EAC NON-MEDICARE 01/87 09/97
4111 EAC <1 M & F NON-MEDICARE 10/97  
4112 EAC 01-05 M & F NON-MEDICARE 10/97  
4113 EAC 06-13 M & F NON-MEDICARE 10/97  
4114 EAC 14-20 MALE NON-MEDICARE 10/96  
4115 EAC 14-20 FEMALE NON-MEDICARE 10/96   
420A ELIC < 1 M & F WITH MEDICARE PPC 10/96  
420B ELIC 01-05 M & F WITH MEDICARE PPC 10/96  
420C ELIC 06-13 M & F WITH MEDICARE PPC 10/96  
420D ELIC 14-20 MALE WITH MEDICARE PPC 10/96  
420E ELIC 14-20 FEMALE WITH MEDICARE PPC 10/96  
4200 ELIC WITH MEDICARE 01/87 09/97
4201 ELIC <1 M & F WITH MEDICARE 10/97  
4202 ELIC 01-05 M & F WITH MEDICARE 10/97  
4203 ELIC 06-13 M & F WITH MEDICARE 10/97  
4204 ELIC 14-20 MALE WITH MEDICARE 10/96  
4205 ELIC 14-20 FEMALE WITH MEDICARE 10/96  
421A ELIC < 1 M & F NON-MEDICARE PPC 10/96  
421B ELIC 01-05 M & F NON-MEDICARE PPC 10/96  
421C ELIC 06-13 M & F NON-MEDICARE PPC 10/96  
421D ELIC 14-20 MALE NON-MEDICARE PPC 10/96  
421E ELIC 14-20 FEMALE NON-MEDICARE PPC 10/96  
4210 ELIC NON-MEDICARE 01/87 09/97
4211 ELIC <1 M & F NON-MEDICARE 10/97  
4212 ELIC 01-05 M & F NON-MEDICARE 10/97  
4213 ELIC 06-13 M & F NON-MEDICARE 10/97  
4214 ELIC 14-20 MALE NON-MEDICARE 10/96  
4215 ELIC 14-20 FEMALE NON-MEDICARE 10/96  
430A SOBRA CHILD < 1 M & F W/MEDICARE PPC 10/96  
430B SOBRA CHILD 01-05 M & F W/MEDICARE PPC 10/96  
430C SOBRA CHILD 06-13 M & F W/MEDICARE PPC 10/96  
430D SOBRA CHILD 14-20 MALE W/MEDICARE PPC 10/96  
430E SOBRA CHILD 14-20 FEMALE W/MEDICARE PPC 10/96  
4300 SOBRA CHILD WITH MEDICARE 01/88 09/97
4301 SOBRA CHILD <1 M & F W/MEDICARE 10/97  
4302 SOBRA CHILD 01-05 M & F W/MEDICARE 10/97  
4303 SOBRA CHILD 06-13 M & F W/MEDICARE 10/97  
4304 SOBRA CHILD 14-20 MALE W/MEDICARE 10/97  
4305 SOBRA CHILD 14-20 FEMALE W/MEDICARE 10/97  
431A SOBRA CHILD < 1 M & F NON-MEDICARE PPC 10/96  
431B SOBRA CHILD 01-05 M & F NON-MEDICARE PPC 10/96  
431C SOBRA CHILD 06-13 M & NON-MEDICARE PPC 10/96  
431D SOBRA CHILD 14-20 MALE NON-MEDICARE PPC 10/96  
431E SOBRA CHILD 14-20 FEMALE NON-MEDICARE PP 10/96  
4310 SOBRA CHILD NON-MEDICARE 01/88 09/97
4311 SOBRA CHILD <1 M & F NON-MEDICARE 10/97  
4312 SOBRA CHILD 01-05 M & F NON-MEDICARE 10/97  
4313 SOBRA CHILD 06-13 M & F NON-MEDICARE 10/97  
4314 SOBRA CHILD 14-20 MALE NON-MEDICARE 10/97  
4315 SOBRA CHILD 14-20 FEMALE NON-MEDICARE 10/97  
432A SOBRA CHILD < 1 M & F WITH QMB PPC 10/96  
432B SOBRA CHILD 01-05 M & F WITH QMB PPC 10/96  
432C SOBRA CHILD 06-13 M & F WITH QMB PPC 10/96  
432D SOBRA CHILD 14-20 MALE WITH QMB PPC 10/96  
432E SOBRA CHILD 14-20 FEMALE WITH QMB PPC 10/96  
4320 SOBRA CHILD WITH QMB 01/88 09/97
4321 SOBRA CHILD <1 M & F WITH QMB 10/97  
4322 SOBRA CHILD 01-05 M & F WITH QMB 10/97  
4323 SOBRA CHILD 06-13 M & F WITH QMB 10/97  
4324 SOBRA CHILD 14-20 MALE WITH QMB 10/97  
4325 SOBRA CHILD 14-20 FEMALE WITH QMB 10/97  

5000's

CODE DESCRIPTION BEGIN DATE END DATE
500C SOBRA PREG 09-13 FEMALE W/MEDICARE PPC 10/96  
500E SOBRA PREG 14-20 FEMALE W/MEDICARE PPC 10/96  
500G SOBRA PREG 21-44 FEMALE W/MEDICARE PPC 10/96  
500H SOBRA PREG 45-64 FEMALE W/MEDICARE PPC 10/96  
5000 SOBRA PREGNANT WOMAN WITH MEDICARE 01/88 09/97
5003 SOBRA PREG 09-13 FEMALE WITH MEDICARE 10/97  
5005 SOBRA PREG 14-20 FEMALE WITH MEDICARE 10/97  
5007 SOBRA PREG 21-44 FEMALE WITH MEDICARE 10/97  
5008 SOBRA PREG 45-64 FEMALE WITH MEDICARE 10/97  
501C SOBRA PREG 09-13 FEMALE NON-MEDICARE PPC 10/96  
501E SOBRA PREG 14-20 FEMALE NON-MEDICARE PPC 10/96  
501G SOBRA PREG 21-44 FEMALE NON-MEDICARE PPC 10/96  
501H SOBRA PREG 45-64 FEMALE NON-MEDICARE PPC 10/96  
5010 SOBRA PREGNANT WOMAN NON-MEDICARE 01/88 09/97
5013 SOBRA PREG 09-13 FEMALE NON-MEDICARE 10/97  
5015 SOBRA PREG 14-20 FEMALE NON-MEDICARE 10/97  
5017 SOBRA PREG 21-44 FEMALE NON-MEDICARE 10/97  
5018 SOBRA PREG 45-64 FEMALE NON-MEDICARE 10/97   
502C SOBRA PREG 09-13 FEMALE WITH QMB PPC 10/96  
502E SOBRA PREG 14-20 FEMALE WITH QMB PPC 10/96  
502G SOBRA PREG 21-44 FEMALE WITH QMB PPC 10/96  
502H SOBRA PREG 45-64 FEMALE WITH QMB PPC 10/96  
5020 SOBRA PREGNANT WOMAN WITH QMB 01/88 09/97
5023 SOBRA PREG 09-13 FEMALE WITH QMB 10/97  
5025 SOBRA PREG 14-20 FEMALE WITH QMB 10/97  
5027 SOBRA PREG 21-44 FEMALE WITH QMB 10/97  
5028 SOBRA PREG 45-64 FEMALE WITH QMB 10/97  
5500 SOBRA FPS FEMALE WITH MEDICARE 10/97  
5510 SOBRA FPS FEMALE WITH NON-MEDICARE 10/97  
5520 SOBRA FPS FEMALE WITH QMB 10/97  

6000's

CODE DESCRIPTION BEGIN DATE END DATE
6011 KIDS <1 M/F NON-MEDICARE 11/98  
6012 KIDS 1-5 M&F NON-MEDICARE 11/98  
6013 KIDS 6-13 M&F NON-MEDICARE 11/98  
6014 KIDS 14-19 MALE NON-MEDICARE 11/98  
6015 KIDS 14-19 FEMALE NON-MEDICARE 11/98  
6514 SOBRA HIFA 14-20 MALE NON-MEDICARE 10/01/02  
6515 SOBRA HIFA 14-20 FEMALE NON-MEDICARE 10/01/02  
6516 SOBRA HIFA 21-44 MALE NON-MEDICARE 10/01/02  
6517 SOBRA HIFA 21-44 FEMALE NON-MEDICARE 10/01/02  
6518 SOBRA HIFA 45-64 MALE/FEMALE NON-MEDICARE 10/01/02  
6519 SOBRA HIFA 65+ MALE/FEMALE NON-MEDICARE 10/01/02  
6614 KC HIFA 14-20 MALE NON-MEDICARE 10/01/02  
6615 KC HIFA 14-20 FEMALE NON-MEDICARE 10/01/02  
6616 KC HIFA 21-44 MALE NON-MEDICARE 10/01/02  
6617 KC HIFA 21-44 FEMALE NON-MEDICARE 10/01/02  
6618 KC HIFA 45-64 MALE/FEMALE NON-MEDICARE 10/01/02  
6619 KC HIFA 65+ MALE/FEMALE NON-MEDICARE 10/01/02  

7000's

CODE DESCRIPTION BEGIN DATE END DATE
7000 CMHS 11/92  
7100 SMI 11/92  
7200 CMHS/DD/18-20 11/92  
7300 CMHS/SED 11/92  
7400 GENERAL MENTAL HEALTH SERVICES 10/95  
7600 SUBSTANCE ABUSE MENTAL HEALTH SERVICES 10/95  

8000's

CODE DESCRIPTION BEGIN DATE END DATE
8020 QMB ONLY 07/89  
850Z SSI AGED TICKET/WORK W/MDC PPC 10/01  
8500 SSI AGED TICKET/WORK W/MDC 10/01  
851Z SSI AGED TICKET/WORK NON-MDC PPC 10/01  
8510 SSI AGED TICKET/WORK NON-MDC 10/01  
852Z SSI AGED TICKET/WORK W/QMB PPC 10/01  
8520 SSI AGED TICKET/WORK W/QMB 10/01  
860Z SSI BLIND TICKET/WORK W/MDC PPC 10/01  
8600 SSI BLIND TICKET/WORK W/MDC 10/01  
861Z SSI BLIND TICKET/WORK NON-MDC PPC 10/01  
8610 SSI BLIND TICKET/WORK NON-MDC 10/01  
862Z SSI BLIND TICKET/WORK W/QMB PPC 10/01  
8620 SSI BLIND TICKET/WORK W/QMB 10/01  
870Z SSI DISABLED TICKET/WORK W/MDC PPC 10/01  
8700 SSI DISABLED TICKET/WORK W/MDC 10/01  
871Z SSI DISABLED TICKET/WORK NON-MDC PPC 10/01  
8710 SSI DISABLED TICKET/WORK NON-MDC 10/01  
872Z SSI DISABLED TICKET/WORK W/QMB PPC 10/01  
8720 SSI DISABLED TICKET/WORK W/QMB 10/01  

9000's

CODE DESCRIPTION BEGIN DATE END DATE
9900 HOSPITALIZED KICK PAYMENT 10/01  
9910 TANF & SOBRA CHILDREN KICK PAYMENT 10/99  
9911 SB PAYMENT FOR TANF EXPANDED 07/01  
9920 SSI W/MEDICARE KICK PAYMENT 10/99  
9921 SSI W/O MEDICARE KICK PAYMENT 10/99  
9922 SB PAYMENT FOR SSI EXPANDED W/MDC 04/01  
9923 SB PAYMENT FOR SSI EXPANDED NO MDC 04/01  
9930 EAC/ELIC * MN/MI KICK PAYMENT 10/99  
9933 SB PAYMENT FOR AHCCCS CARE 10/01  
9934 SB PAYMENT FOR MED ELIGIBLES 04/01  
9935 SB PAYMENT FOR AHC CARE HOSPITALIZED 10/01  
9936 SB PAYMENT FOR AHC CARE/MI 04/01  
9937 SB PAYMENT FOR AHC CARE/MI HOSPITALIZED 10/01  
9938 SB PAYMENT FOR MED HOSPITALIZED 10/01  
9950 SOBRA WOMAN KICK PAYMENT 10/99  
9960 KIDSCARE KICK PAYMENT 10/99  
9990 SOBRA SUPPLEMENTAL PMT 10/97  
9997 SOBRA SUPP PAYMENT (SPEC. CAP) 01/88 09/97
CODE DESCRIPTION
A Absent Parent (CSEA)
C Child
G Guarantor
L Legal Guardian
O Other
P Parent
S Self
CODE DESCRIPTION
BB Bed-Bound
CC LTC Facility Conv Care
CH Chemotherapy
DI Dialysis
ER ER-ACC/Injury Related
HA Hospitalized-ACC/INJ Rel
HI Head Injury
HK Hospitalized - Kick Payment
HS Hospitalized
NN NB-Normal
OA Outpatient-ACC/INJ Relat
PG Pregnant
PR Pregnant-High Risk
RT Radiation Therapy
SI Spinal Cord Injury
SN NB-Sick
ST Surgical Sterilization
TP Transplants
COUNTY DESCRIPTION GSA
01 Apache 16
03 Cochise 18
05 Coconino 06
07 Gila 08
09 Graham 14
11 Greenlee 14
13 Maricopa 12
15 Mohave 04
17 Navajo 16
19 Pima 10
21 Pinal 08
23 Santa Cruz 18
25 Yavapai 06
27 Yuma 02
29 La Paz 04
31 Out of State  
33 Out of Country  
35 Unknown  
99 Statewide (for pricing)  
CODE DESCRIPTION TYPE INDICATOR
$P MANUAL PAYMENT A Y
$R MANUAL RECOUPMENT D Y
AA ALGORITHM ASSIGNED A N
AC ADDRESS CHANGE C N
AE APPLIED FOR NEW ELIGIBLITY D Y
AI ADMIN-IN A N
AO ADMIN-OUT D Y
BI ENROLLMENT BLOCK IN A N
BO ENROLLMENT BLOCK OUT D Y
CH ELIG CHANGE CAUSES DISENRL D Y
CI COUNTY MOVE-IN A N
CO COUNTY MOVE-OUT D Y
DB DATE OF BIRTH CHANGE C N
DE DECEASED D Y
EC ENROLLMENT CHOICE A N
EI OPEN ENROLLMENT-IN A N
EO OPEN ENROLLMENT-OUT D Y
FI FAMILY CONTINUITY-IN A N
FO FAMILY CONTINUITY-OUT D Y
HC ACUTE HEALTH PLAN CHANGE C N
HK HOSPITALIZED, KICK TO BE PAID    
HO MOVE OUT OF HEALTH PLAN AREA D Y
IE INELIGIBLE D Y
MA MASS ADJUSTMENT RECOUPMENT D Y
MC MENTAL HEALTH CHANGE C N
MI MEDICAL CARE CONTINUITY-IN A N
MO MEDICAL CARE CONTINUITY-OUT D Y
MR MASS ADJUSTMENT PAYMENT A Y
NB NEWBORN A N
NC NAME CHANGE C N
NE NORMAL ENROLLMENT A N
NP NORMAL ENROLLMENT-PRIOR PLAN A N
OS OUT OF STATE MOVE D Y
PA END OF CONTRACT-IN: AUTO ASSIGN A N
PD END OF CONTRACT-IN: DIRECT MOVE A N
PG PREGNANT WOMEN C N
PO END OF CONTRACT-OUT: DIRECT MOVE D Y
PP END OF CONTRACT-IN: PERCENTAGE A N
PR END OF CONTRACT-IN: RULE MATRIX A N
PT END OF CONTRACT-OUT: %, AUTO, RULE D Y
RA RETROACTIVE ENROLLMENT A N
RC RATE CODE CHANGE C N
RE RE-ENROLLMENT A N
RO RECOUPMENT MHS D Y
SB SUPPLEMENTAL BIRTH PAYMENT C N
SC SHARE OF COST CHANGE C N
SX SEX CHANGE C N
TM MENTAL HEALTH TERMINATION C N
VW VOLUNTARY WITHDRAWAL D Y
TYPE CONTRACT CODE DESCRIPTION CAP
Ind		 FFS
Ind
% CRS/CAP Children's Rehab Services, Capitation Y N
@ DES/DD/RI DES DD Reinsurance Indicator N N
A ACU/CAP Acute Capitated Y N
B ACU/CAP/PAR Acute Partially Capitated Y Y
C ACU/CAP/ACU Acute Capitated Acute SVCS Only Y N
D ACU/FFS/ACU Acute Fee for Service Acute Only N Y
E ACU/FFS Acute Fee for Service N Y
F ACU/FFS/EMO Acute FFS Emergency Services Only N Y
G ACU/FFS/FPS Acute Fee For Service, Family Planning Services N Y
H ACU/PPC Acute Prior Period Coverage Y N
I ACU/PPC/EMO Acute Prior Period Coverage Emergency Svcs Y N
J LTC/CAP Long Term Care Capitated Y N
K MHS/CAP/ACU Mental Health Svcs, Cap Acute Only Y N
L LTC/CAP/ACU Long Term Care Cap Acute Only Y N
M LTC/PPC Long Term Care Prior Period Coverage Y N
N ACU/NBN Acute Newborn Non-Capped N N
O LTC/PPC/ACU Long Term Care Prior Period Coverage Acute Y N
P LTC/CAP/PAR Long Term Care Partial Cap Y Y
Q ACU/CAP/FPS Acute Capitated FPS Only Y N
R LTC/FFS Long Term Care FFS N Y
S MHS/CAP/DD Mental Health Services Cap DD Y N
T LTC/FFS/ACU Long Term Care FFS Acute Only Y Y
U UNDOC/FFS/EM Undoc. Aliens, FFS, Emg Svc Only N Y
V MHS/Cap/KC Mental Health Services Capitated Kidscare Y N
W ACU/KC/NoPay ADHS Direct Services Kidscare No Payment N N
X ACU/FFS/KC Acute FFS Kidscare N Y
Y ACU/CAP/KC Acute Capitated Kidscare Y N
2 LTC/VD/CAP/F LTC Vent Dependent Cap Full Svc Y N
3 LTC/FFS/VD Long Term Care FFS VD Y Y
4 LTC/VD/CAP/A LTC Vent Dependent Cap Acute Svc Y N
5 LTC/FFS/VHA Long Term Care FFS VD Acute Only Y Y
8 NON/PAY No Payment Permitted N N
CODE DESCRIPTION
AF AFDC
EA EAC
EL ELIC
FP SOBRA Women Family Planning Services
MI Medically Indigent
MN Medically Needy
QA QMB Only Aged
QB QMB Only Blind
QD QMB Only Disabled
QO QMB Only Other
SA SSI Aged
SB SSI Blind
SD SSI Disabled
SF State Funded
SI SSI
SO Sobra Woman
TA TANF