TITLE:

HMKR559Q - TPL Segment End Date Report

FREQUENCY/MEDIA:

Monthly/paper

FICHE HEADER:

n/a

JOB NAME:

OBJECTIVE:

The purpose of this report is to identify recipients that have had an end date applied to the TPL segment the previous month.  the report is used by certifying agencies and child support as an aid to identify additional insurance coverage, or ensure child support enforcement when insurance coverage is court ordered.  One copy of the report is produced and distributed by EDS to certifying and child support agencies.

ORGANIZATION:

Sorted in ascending order by agency code, by absent parent code, by worker number, and then by case head name.

EXCLUSIONS/LIMITATIONS:

Recipients having an end date changed in the last month, but currently not eligible for Medical Assistance are excluded.  TPL segments which were deleted from the eligibility file are excluded.  TPL segments end dated due to T and E link are also excluded.  All other T-Segments having end dates applied during the current month are included.

FIELD DESCRIPTIONS:

ABSENT PARENT:

 Identifies the policyholder as a parent who is absent from the home.  Absent parent code is converted as follows:

1 – yes

0 – no

COUNTY:

Three-digit numeric code identifying the certifying agency and, in most cases, the county in which the agency is located.  Descriptions of certifying agency codes can be found in Quick Reference.

AGENCY ( AGC ):

Two-digit numeric code identifying the specific W2 or non-W2 agency within a county.  Description of agencies can be found in Quick Reference.

IM WORKER:

Six-digit agency worker number from the recipient’s B-segment.

CARES Client Assistance for Re-employment & Economic Support CASE:

10-digit identifier assigned by CARES to a group of CARES eligible recipients.

ORG

TPL origin code.  One-byte.  Identifies the system by which TPL was established.  Valid values are C ( CARES ), K ( KIDS ), and M ( MMIS ).

INSTRUCTIONAL MESSAGE

A message informing each agency how to use the report.

CASE HEAD LAST FIRST

Casehead's last and first name (e.g., parent of a child).

RECIPIENT LAST FIRST

Name of individual receiving Medical Assistance services.

MA NUMBER

Recipient's 10-digit Medical Assistance identification number.

POLICY HOLDER LAST FIRST

Insured's last and first name from the end dated TPL segment.

POLICY NUMBER

Policy number for the end dated TPL segment.

ENDED POLICY

Name of the insurance carrier from the end dated TPL segment.

END DATE

Date the insurance ended from the TPL segment.

SOURCE

Written description of the source of update information as identified by the source code on the end dated TPL segment.  The source codes are converted as follows:

1 – DHCF

2 - Insurance Company

3 – Unknown

4 - Child Support Agency

5 – Agency

6 – HIPP

7 – Insurance Disclosure

SECOND TPL SEGMENT

If a TPL segment on the recipient's file still exists with an open end date, the name of the insurance carrier is printed.