Appeal and Grievance Quick Reference Guide for Providers
Plan or Account Name Blue Cross Blue Shield of Arizona (BCBSAZ) Alpha Prefix on ID Card
HMO: XBG, XBH, XBK PPO: XBB, XBM, XBP, UHL* Other group-specific alpha prefixes may be assigned to certain 1000+ groups. Refer to the BCBSAZ Alpha Prefix Grid on azblue.com for a listing. *Level 1 appeals only Indemnity: XBC, XBF Medicare Supplements: XBS Dental only: XBW DentalChoice: The alpha prefix is the same prefix as on the members medical ID card when DentalChoice is a benefit. (Generally, the word DENTAL appears on the ID card.)
Appeal and Grievance Address and Mail stop Information

Claims Issues: Level 1

Customer Service Claims Dept. Mail Stop N104 BCBSAZ P.O. Box 13466 Phoenix, AZ 85002

Medical Issues: Level 1

ManagerMedical Appeals and Grievances Mail Stop A116 BCBSAZ P.O. Box 13466 Phoenix, AZ 85002 Fax: (602) 544-5601
Claims and Medical Issues: Level 2 Grievances and Level 2 and 3 Appeals
Medical Appeals and Grievances Coordinator Mail Stop A116 BCBSAZ P.O. Box 13466 Phoenix, AZ 85002 Fax: (602) 544-5601
BlueCard: Out-of-state Blue Plans
Minimum of three letter alpha prefix, but varies by state and Blue Plan.
Claim Issues: Level 1 and Level 2
Blue Card Host Claims Mail Stop E106 BCBSAZ P.O. Box 13466 Phoenix, AZ 85002 Fax: (602) 864-5120
Note: Please send all BlueCard grievances directly to BCBSAZ. BCBSAZ will handle disputes related to claims coding and pricing, and will forward all other disputes to the Home Plan for resolution.
Federal Employee Program (FEP)
R followed by eight numeric characters. (For both medical and dental plans).
FEP Claims and Medical Issues: Level 1 and Level 2
FEP Customer Service Mail Stop P105 BCBSAZ P.O. Box 13466 Phoenix, AZ 85002 FEP Medical Review Mail Stop P102 P.O. Box 13466 Phoenix, AZ 85002 Fax: (602) 864-4664
FEP Precertification Issues: Level 1 and Level 2
Corporate Health Service (CHS) Accounts
No alpha prefix on ID card, but group number is required.
Note: For CHS claims, submit pricing related grievances directly to BCBSAZ and all other appeals and grievances directly to the TPA.

10-0266

Level 1 = 1st time issue is appealed Level 2 and 3 = Subsequent appeals

3-15-10

(See reverse side for additional information.) 14298 0310
BCBSAZ Appeal and Grievance Quick Reference Guide for Providers Reason for Appeal or Grievance and Documentation Required

Examples of Grievances

Grievances processed by the Claims Dept.
COB issues Coinsurance/deductible and sanction deductible Fee schedule disputes Timely filing

Documentation Required

Detailed explanation of issue or correction BCBSAZ claim number Copy of corrected claim, if applicable Evidence of primary payer reimbursement (for COB issues)
Grievances processed by the Medical Appeals and Grievance Dept.
Outpatient global pricing DRG payment Fragmentation of incidental procedures Modifiers Multiple medical/surgical procedure processing Mutually exclusive procedures Procedure unbundling Denials based on investigational or medical necessity determinations that require a provider write-off

submission to BCBSAZ.

Proof of claims filing and timeliness Paper claim: A copy of the computer screen-print showing date of
Electronic claim: A copy of the APN report showing receipt of the clean claim by BCBSAZ. For both claim types: Include dates of timely follow-up with BCBSAZ and the BCBSAZ contact name.
Examples of Appeals Filed on Behalf of a Member Documentation Required
Appeals processed by the Medical Appeals and Grievance Dept.
Detailed explanation of issue Must be accompanied by applicable medial records and/or operative report to support explanation (Please note: failure to submit supporting documentation may delay processing of your request.)

Assistant surgeon Benefit plan limitations Claims that deny for no precertification Cosmetic procedures Dental appeals Eligibility (member) Contract exclusions Ineligible provider Pre-existing conditions Waived conditions Investigational (member responsible) Not medically or dentally necessary (member responsible)
BCBSAZ timeframes to file Appeals and Grievances Level 1 Claim Appeal: Should be filed within two years from initial denial. (FEP Appeals must be filed within one year.) Level 2 Claim Appeal: Should be filed within 60 days of Level 1 determination. Level 3 Claim Appeal: Should be filed within 30 days of Level 2 determination. (FEP is excluded from Level 3 appeals.) Level 1 Grievance: Should be filed within one year of claim processed date. Level 2 Grievance: Should be filed within 60 days of the Level 1 determination. Timeframes for FEP, BlueCard and CHS accounts may vary. Important reminders: Please include the member name, member ID, claim #, provider name, provider NPI #, contact person and phone number on all appeals.
Send the appeal to the appropriate address and mail stop as indicated on the previous page; otherwise, delays in processing may occur. The Health Coverage Appeal Request Form and Provider Certification Form for Expedited Medical Review are components of the BCBSAZ Health Coverage Appeals Packet. Although you may use these forms, the phone numbers referencing the Arizona Department of Insurance apply only to those products under the BCBSAZ Health Coverage Appeals Process.
This is a brief summary only and is not an all-inclusive list of the appeals processes available. Please refer to the appeal and grievance procedures outlined on our Web site at azblue.com, or in Section 13 of the Provider Operating Guide for a complete explanation of the BCBSAZ Appeal and Grievance process, including expedited appeals.

14298 0310

PROVIDER Grievance Form
(This is an OPTIONAL form.) Send to appropriate address listed on Appeal and Grievance Quick Reference Guide. Include Mail Stop: ________________ Date ________ Name of Provider ___________________________________________ Provider NPI # or Tax ID ____________________ Mailing Address _________________________________________________________________________________________________ City _________________________________________________________________ State ____________ ZIP Code __________________ Contact Person _______________________________________________________ Phone # ____________________________________ Member Name ________________________________________________ Member ID # _____________

(Alpha Prefix)

________________________

(ID Number)

Date(s) of Service ________________________ Claim # ____________________________ Patient Account # ______________________
Plan or Account Name and Alpha Prefix
BCBSAZ Includes XBB, XBC, XBF, XBG, XBH, XBK, XBM, XBP, XBS, XBW, UHL* Other group-specific alpha prefixes may be assigned to certain 1000+ groups. Refer to the BCBSAZ Alpha Prefix Grid on azblue.com for a listing of additional alpha prefixes. Federal Employee Program (FEP) Alpha prefix R followed by eight numeric characters. Blue Card (Out-of-state) Note: The minimum of three letter alpha prefix varies by Blue Plan. Please send all BlueCard grievances directly to BCBSAZ. BCBSAZ will handle disputes related to claims coding and pricing, and will forward all other disputes to the Home plan for resolution.

* Level 1 appeals only

Reason for Grievance Please provide a detailed description of the issue and include appropriate documentation to support your position (medical records, operative report, etc.). Refer to the Quick Reference Guide for the category of the issue or for the department handling the grievance.
Please check appropriate box: Level 1 Grievance Level 2 Grievance

3-15-0310

Health Coverage Appeal Request Form
You may use this form to tell BCBSAZ you want to appeal a denial decision. Member Name Name of representative pursuing appeal, if different from above Mailing Address Phone # City Type of Denial: Denied Claim State Zip Code Member ID#
Denied Service Not Yet Received
If you are appealing BCBSAZs decision to deny a service you have not yet received, could a 30 to 60 day delay in receiving the service likely seriously jeopardize your life or health or your ability to regain maximum function or subject you to severe pain that cannot be adequately managed without the care or treatment that is the subject of the request? If your answer is Yes, you may be entitled to an expedited appeal. Your treating provider must sign and send a certification and documentation supporting the need for an expedited appeal. What decision are you appealing?
(Explain what you want BCBSAZ to authorize or pay for.) Explain why you believe the claim or service should be covered:
(Attach additional sheets of paper, if needed.) If you have questions about the appeals process or need help to prepare your Appeal, you may call the Arizona Department of Insurance Consumer Assistance number (602) 364-2499 or (800) 325-2548, or BCBSAZ at (602) 864-4400 or (800) 232-2345. Make sure to attach everything that shows why you believe BCBSAZ should cover your claim or authorize a service, Supporting documentation (letter from your doctor, brochures, notes, receipts, etc.) including: Medical records **Also attach the certification from your treating provider if you are seeking expedited review. Medical Appeals and Grievances Department Mail Stop A116 BCBSAZ P.O. Box 13466 Phoenix, AZ 85002-3466 Fax: (602) 544-5601 Phone: (602) 544-4938 or (866) 595-5998 Date

Signature of insured or authorized representative
Provider Certification Form for Expedited Medical Review
(You and your provider may use this form when requesting an expedited appeal.) Is the appeal for a service that the patient has already received? Yes No If Yes, the patient must pursue the standard appeals process and cannot use the expedited appeals process. If No, continue with this form. A patient who is denied authorization for a covered service not yet provided is entitled to an expedited appeal if the treating provider certifies and provides supporting documentation that the time period for the standard appeal process could seriously jeopardize your life or health or your ability to regain maximum function or would subject you to severe pain that cannot be adequately managed without the care or treatment that is the subject of the request.

Provider Information

Treating Physician/Provider Phone # Fax # State Zip Code Address City

Patient Information

Member Name Phone # Address City State Zip Code Fax # Member ID#

Insurer Information

Insurer Name Phone # Address What service denial is the patient appealing? Explain why you believe the patient needs the requested service and why the time for the standard appeal process will harm the patient. Fax # State Zip Code
Attach additional sheets if needed and include:

Medical records

Supporting documentation
If you have questions about the appeals process or need help to prepare your Appeal, you may call the Arizona Department of Insurance Consumer Assistance number (602) 364-2499 or (800) 325-2548, or BCBSAZ at (602) 864-4400 or (800) 232-2345. I certify, as the patients treating provider, that delaying the patients care for the time period needed for the informal reconsideration and formal appeal processes (about 60 days) is likely to seriously jeopardize the patients life, health or ability to regain maximum function or subject the patient to severe pain that cannot be adequately managed with the care of treatment that is the subject of the request. Providers Signature

D12518 07/07

12518 1008

Coaxial Adapters

SSMA Male SMA Male Female Male Female Male SM-SM SM-SF SMA Female SM-SF SF-SF Male MDC3037 MDC3033 MDC6234 MDC6004 SMB Female MDC3038 MDC3034 MDC6004 MDC6237 Male MDC3039 MDC3035 SMC Female MDC3040 MDC3036 Male BM-SM BM-SF BN C Female BF-SM BF-SF

Adapter Tables

A convenient Adapter Part Number Table, Adapter Code Table, and Adapter Construction Table can help
you find a part number. They can also help you understand our part numbering system. Since there are many combinations possible, only some of the most common are shown here. Please call if you dont see exactly what you need.
Type N Male NM-SM NM-SF Female NF-SM NF-SF Male TM-SM TM-SF TN C Female TF-SM TF-SF MDC4031-3 MDC4031-4 MDC4031-1 MDC4031-2 BM-TF BF-TF NM-TF NF-TF TM-TF TF-TF MDC7914 MDC7908
MDC3314 MDC3100 MDC3312 MDC3313 MDC7916-3 MDC7915-3
MDC3037 MDC3033 MDC3038 MDC3034 MDC3039 MDC3035 MDC3040 MDC3036 BM-SM BF-SM NM-SM NF-SM TM-SM TF-SM BM-SF BF-SF NM-SF NF-SF T MS F TF-SF
MDC3041 MDC3042 MDC3045 MDC8134 MDC3044 MDC8001
MDC4021-3 MDC4030-3 MDC4024-3 MDC4021-4 MDC4030-4 MDC4024-4 MDC4021-1 MDC4030-1 MDC4024-1 MDC4021-2 MDC4030-2 MDC4024-2 BM-BM BM-BF NM-BM NF-BM BM-TM BM-TF MDC7909 MDC7903 BM-BF BF-BF NM-BF NF-BF BF-TM BF-TF MDC7910 MDC7904 NM-BM NM-BF NM-NM NM-NF NM-TM NM-TF MDC7911 MDC7905
MDC4032-3 MDC4027-3 MDC4032-4 MDC4027-4 MDC4032-1 MDC4027-1 MDC4032-2 MDC4027-2 NF-BM NF-BF NM-NF NF-NF NF-TM NF-TF MDC7912 MDC7906 BM-TM BF-TM NM-TM NF-TM TM-TM TM-TF MDC7913 MDC7907
Female MDC7916-4 MDC7915-4 Male MDC7916-1 MDC7915-1
MDC3041 MDC3045 MDC3042 MDC3044
Female MDC7916-2 MDC7915-2 Male Female Male Female Male Female Male Female MDC7909 MDC7903 MDC7910 MDC7904 MDC7911 MDC7905 MDC7912 MDC7906 MDC7913 MDC7907 MDC7914 MDC7908 MDC1143 MDC1144 MDC1144 MDC1142
MDC8001 MDC8137 MDC4021-1 MDC4021-2 MDC4030-1 MDC4030-2 MDC4024-1 MDC4024-2 MDC4032-1 MDC4032-2 MDC4027-1 MDC4027-2 MDC4031-1 MDC4031-2 MDC7916-1 MDC7916-2 MDC7915-1 MDC7915-2
MDC4021-3 MDC4021-4 MDC4030-3 MDC4030-4 MDC4024-3 MDC4024-4 MDC4032-3 MDC4032-4 MDC4027-3 MDC4027-4 MDC4031-3 MDC4031-4
MDC3314 MDC3312 MDC7916-3 MDC7916-4 MDC3100 MDC3313 MDC7915-3 MDC7915-4
Most standard adapters are nickel plated brass except SMA and SSMA which are usually gold plated stainless steel. When available, particular adapters in the MDC3XXX series can be ordered with a passivated finish by adding S to the part number. In the MDC4XXX series, add G to part number for gold plating. Adapter Code Table
BNC C 874 HN N SC SMA TNC UHF Male Female Bulkhead Right Angle Radius (swept) Panel (flange) usage through 18 GHz: Precision Examples N (male) to SMA (female) TNC (female) to SMA (male) BNC (male) to BNC (female) Precision panel mount N (female) to SMA (female) Bulkhead N (male) to SMA (female) B C 874 H N SC S T U M F Prefix with B Prefix with R RR Prefix with P Prefix with X Part No. NM-SF TF-SM BM-BF XPNF-SF BNM-SF
General Adapter Information
(Consult factory for additional information) Many MIDISCO adapters are available with one or both interfaces reverse polarized (RP), indicated by adding the suffix RP after the series designator. For example, a standard Type N Plug to SMA jack adapter is a NM-SF. If the type N side is reverse polarized, the part number is NMRP-SF, while reverse polarizing on both sides is indicated as a NMRPSFRP. Although not heavily stressed in this catalog, MIDISCO also has a wide variety of MCX and MMCX inter and intra series adapters. Many BNC, TYPE N, TNC, and MCX (jack-to-jack adapters only) are also available in 75 configurations. A -75 suffix is added to part number. With the exception of the type N series, all 75 adapters will interface mechanically and electrically with their 50 counterparts. The Adapter Part Number Table shown above will aid the user in finding a part number. Page 33 contains and Adapter Suffix Table. It shows how the part numbers for the 4XXX series shown on this page are derived, and provides the user a tool to create part numbers for specific adapters not shown in catalog.

Features

RF leakage: 90 dB (min.) Dielectric withstanding voltage: 1000Vrms, 60Hz (sea level) Temperature range: -65C to +165C Impedance: 50 ohms (some 75 ohm models available) Delivery from stock

Standard Adapters

Standard adapters
are an inexpensive alternative to the MIDISCO Precision series, when operating at frequencies less than 12 GHz in TNC and type N. Construction is rugged and, wherever applicable, is in accordance with MIL-PRF-39012 and MIL-A-55339. Construction is stainless steel, beryllium copper or brass as the connector series dictates with corresponding plating of gold or nickel as the specification applies.
Additional types, including bulkhead, panel (flange), right angle and other series combinations are also available, usually from stock.
SMA Female to Type N Male SMA Male to Type N Male
SMA Male to Type N Female
SMA Female to Type N Female
NF-SM SMA Male to BNC Male
NF-SF SMA Male to BNC Female
NM-SF SMA Female to BNC Female
NM-SM SMA Female to BNC Male
BM-SM SMA Female to TNC Female
BF-SM SMA Female to TNC Male
BF-SF SMA Male to TNC Male
BM-SF SMA Male to TNC Female
TF-SF Type N Female to BNC Male
TM-SF BNC Female to TNC Male
TM-SM BNC Female to Type N Male
TF-SM TNC Female to BNC Male
NF-BM BNC Female to UHF Male
BF-TM BNC Female to Type C Male
NM-BF UHF Female to BNC Male
BM-TF TNC Female to Female Adapter
UM-BF CM-BF UF-BM TF-TF For precision stainless steel construction where applicable Prefix X (See precision adapters section). All dimensions shown in inches (mm). Note: Dimensions are for reference only and are subject to change.
TNC Male to Type N Male TNC Female to Type N Male TNC Male to TNC Male
TNC Male to Type N Female

BNC Female to Female

BNC Male to Male

BNC Tee - 3 Female

BNC Female, Male, Female

BF-BF-BF

BF-BM-BF
BNC T - Female, Female, Male
Right Angle BNC Female to BNC Male
BNC Female to Female Flange Mount
Type N Female to Female Flange Mount

BM-BF-BF

RBF-BM

PBF-BF

PNF-NF

Type N Female to Female

Type N Male to Male

Type N Tee - 3 Females

Type N Male to Right Angle Type N Female

NF-NF-NF

RNF-NM
Type N Tee Female, Male, Female

Type N Tee - 3 Males

Right Angle Type N Male to Type N Male
Type N Tee Female, Female, Male

NF-NM-NF

NM-NM-NM

RNM-NM

NF-NF-NM
Standard Material & Finish: Non-Tarnish (Nickel) Plated Brass For Precision Stainless Steel Construction where applicable Prefix X (See Precision Adapter Section)
All dimensions shown in inches (milllimeters) Note: Dimensions are for reference and are subject to change.
SC Adapters SC Male to SC Male SC Female to SC Female
900 Adapters Right Angle SC Male to SC Female
x: Connector Series y: M=Male F=Female

see adapter code table

SCM-SCM

SCF-SCF MCX Adapters

RSCM-SCF

900-xy SSMB Adapter

MCX Male to MCX Male

MCX Female to MCX Female

MCX Male to MCX Female

SSMB Male to SSMB Male

Bulkhead Mount

MCXM-MCXM

MCXF-MCXF SMB Adapters

MCXM-MCXF

MDC6M243
SMB Male Jack to SMB Male Jack
SMB Female Plug to SMB Female Plug

SMB Tee 3 Male Jacks

SMB Tee 3 Female Plugs

MDC6234

MDC6237 SMC Adapters

MDC6328

MDC6329
SMC Male Jack to SMC Male Jack
SMC Female Plug to SMC Female Plug

SMC Tee 3 Male Jacks

SMC Tee 3 Female Plugs

MDC8134

MDC8137 SMB to SMC Adapters

MDC8128

MDC8129
SMC Male Jack to SMB Male Jack
SMC Female Plug to SMB Male Jack
SMC Female Plug to SMB Female Plug
SMC Male Jack to SMB Female Plug
MDC 3041 All units are 50 ohms unless specified otherwise.

MDC 3042

MDC3044 Note: SMB, SMC, SSMB plugs have female contact. Dimensions are for reference and subject to change.

MDC3045

BNC to Subminiature (SMB, SMC,CMS,SSMB,SSMC,SCMS, 50 & 75 ohm) BNC Plug BNC Bulkhead Jack

Front Mount

BNC Bulkhead Jack

Rear Mount

Adapter Suffix Table
To SMC Male Jack SMC Female Plu g SMB Male Jack Suffix -1 -2 -3 -4 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16

MDC4021- ( )

MDC4022-( )

MDC4023-( )

N to Subminiature (SMB, SMC,CMS,SSMB,SSMC,SCMS, 50 & 75 ohm) N Plug N Bulkhead Jack

N Bulkhead Jack

MDC4024-( )

MDC4025-( )

MDC4026-( )
SMB Female Plu g 75 oh m screw-on Male Jack 75 oh m screw-on Female Plu g 75 oh m sn ap-on Male Jack 75 oh m sn ap-on Female Plu g CMS Male Jack CMS Female Plu g SSMC Male Jack SSMC Female Plu g SSMB Male Jack SSMB Female Plu g SCMS Male Jack SCMS Female Plu g
TNC to Subminiature (SMB, SMC,CMS,SSMB,SSMC,SCMS, 50 & 75 ohm) TNC Plug TNC Bulkhead Jack

TNC Bulkhead Jack

MDC4027-( )
MDC4028-( ) SMA to SMB Adapters

MDC4029-( )

SMB Female to SMA Male

SMB Male to SMA Male

SMB Female to SMA Female

SMB Male to SMA Female

MDC3038S

MDC3037S

MDC3034S

MDC3033S

SMA to SMC Adapters / Frequency: DC-10GHz / VSWR: 1.15 max / Material is Passivated Stainless Steel SMC Female to SMA Male SMC Male to SMA Male SMC Female to SMA Female SMC Male SMA Female

MDC3040S

MDC3039S

MDC3036S

MDC3035S
All units are 50 ohms unless specified otherwise. Material & Finish: Nickel Plated Brass. SMA: Stainless Steel Passivated or Gold Plated per applicable MIL specs. Example: MDC4022-3 is a front mount BNC bulkhead jack to SMB male jack. Note: SMB,SSMB,SMC,SSMC,CMS,SCMS plugs have female contact. SMA plugs have male contact.
For Gold Plated Finish: For MDC4000 Series, add G to basic part number. For MDC3000 Series, drop the S suffix.
Suffix 7 and 8 adapters are available as true 75 ohm connectors (both sides) by
adding /75 to basic part number. The Snap-On side can also be specified as a 75 ohm mini-SMB by adding an M after the 7 or 8 suffix.
Popular Precision Bulkhead Adapter Precision Bulkhead N Fem to SMA Fem

.625 DIA. MIN.531 MIN.

Unique and Popular Adapters
Hermetically Sealed Bulkhead SMA Fem to SMA Fem
Quick Connect or Connector Saver Quick Connect SMA Male to SMA Fem Also available in Type N, TNC, Type F and others.

Coaxial Ad

BNC Female to BNC Female

XBNF-SF-S

QSM-SF-S

HBSF-SF-S

Standard 7/16 DIN SC, SMA, SMB, SMC, SSMA, SSMB, TNC, UHF, 2.4mm, 3.5mm, 7mm, Adapters
BNC 75 ohm Adapters BNC Male to BNC Male Type F Adapters Type F Female to Type F Female Type F Male to Type F Male

BF-BF-75

BM-BM-75 Type N to Type F Adapters
Type N Male to Type F Male
Type N Male to Type F Female
Type N Female to Type F Male
Type N Female to Type F Female
NM-FM 7/16 DIN Male to 7/16 DIN Male
NM-FF 7/16 DIN Adapters 7/16 DIN Female to 7/16 DIN Female
NF-FM Right Angle 7/16 DIN Male to 7/16 DIN Male
NF-FF Right Angle 7/16 DIN Male to 7/16 DIN Female

716M-716M

716F-716F
R716M-716M 7/16 DIN to Type N Adapters

R716M-716F

7/16 DIN Male to Type N Male
7/16 DIN Male to Type N Female
7/16 DIN Female to Type N Male
7/16 DIN Female to Type N Female
716M-NM 7/16 connectors & cable assemblies are also available.

716M-NF

716F-NM

716F-NF

Low VSWR Broadband coverage Simplified numbering Precision construction Smallest size for best performance Bulkhead and panel types Straight or right angle types Radius (bent) configurations Performance to 26 GHz and up Delivery from stock

Precision Adapters

Precision inter and intra series adapters, with performance
to 26 GHz and beyond, appear on the following pages. Construction is in accordance with MIL-PRF-39012 and MIL-A-55339, where applicable. In most cases, material is stainless steel passivated or gold plated, remaining consistent with that normally specified in that connector series. For lower frequency applications, see the MIDISCO standard series adapters in another section of this catalog. Additional adapters, not shown here, are usually from stock. Custom adapters are also available.

/ VSWR: 1.25 GHz (max) / Material is Passivated Stainless Steel N Female to SMA Female* N Female to SMA Male
Frequency: DC-18GHz N Male to SMA Female

N Male to SMA Male

XNM-SF Frequency: DC-18GHz SMA Male to Panel Mount N Male

XNM-SM /

*available as a bulhead, XBNF-SF-S
XNF-SF / Material is Passivated Stainless Steel

XNF-SM

VSWR: 1.25 GHz (max)
SMA Female to Panel Mount N Male
Panel Mount N Female to SMA Male
Panel Mount N Female to SMA Female
See flange A=1.000 B=.125 C=.719 XPNM-SM Frequency: DC-15GHz TNC Male to SMA Female XPNM-SF /
See flange A=1.000 B=.125 C=.719 XPNF-SM
See flange A=1.000 B=.125 C=.719 XPNF-SF
See flange A=1.000 B=.125 C=.719

VSWR: 1.15 GHz (max)

/ Material is Passivated Stainless Steel TNC Female to SMA Female TNC Female to SMA Male

TNC Male to SMA Male

XTM-SF
XTM-SM BNC is Brass with Bright Alloy Finish /
XTF-SF SMA is Passivated Stainless Steel BNC Female to SMA Female

XTF-SM

BNC Male to SMA Female

BNC Male to SMA Male

BNC Female to SMA Male

XBM-SF

XBM-SM

XBF-SF

XBF-SM
Note: Dimensions are for reference and are subject to change.
Frequency: DC-18GHz SMA Male to SMA Male / VSWR: 1.15 GHz (max) / SMA Male to SMA Female* SMA Female to SMA Female
Material is Passivated Stainless Steel Bulkhead SMA Female to SMA Female*
*Hermetically sealed HBSF-SF-S *Quick connect available QSM-SF-S SM-SM-S SM-SF-S SF-SF-S BSF-SF-S Frequency: DC-18GHz / VSWR: 1.20 GHz (max) Frequency: DC-18GHz / VSWR: 1.15 GHz (max) Material is Passivated Stainless Steel Material is Passivated Stainless Steel Right Angle SMA Male to SMA Female Right Angle SMA Male to SMA Male SMA Female to SMA Female with Knurl SMA Female Panel Adapter
See flange on pg 35 A =.500 B =.102 C =.340 MDC3145S / MDC3145S-2 (2 Hole)

RSM-SF-S

RSM-SM-S Unmatched Power Dividers /
MDC3125S Material is Passivated Stainless Steel SMA Tee Male-Male-Male
SMA Tee Female-Female-Female
SMA Tee Female-Male-Female

SMA Tee Male-Female-Male

SF-SF-SF-S
SF-SM-SF-S Frequency: DC-18GHz / VSWR: 1.25 max /
SM-SM-SM-S Material is Passivated Stainless Steel N Male to N Male

SM-SF-SM-S

Panel Mount N Female to N Female

N Female to N Female

N Female to N Male
See flange on pg 35 A = 1.000 B =.125 C =.718 XPNF-NF XNF-NF XNM-NM XNM-NF
SMA Material is Passivated Stainless Steel 874 to SMA Male
Frequency: DC-18 GHz / VSWR: 1.25 max / Material is Passivated Stainless Steel

874-SMA Female

TNC Male to TNC Male

TNC Female to TNC Male

874-SM

874-SF

XTM-TM

XTM-TF-S

874 Adapters are available to BNC, C, HN, N, TNC, UHF, and other series. All dimensions are reference and are subject to slight changes.
Drop the last S in part number for gold-plated body where applicable.
Material is Passivated Stainless Steel N Male to TNC Female N Male to TNC Male N Female to TNC Female

N Female to TNC Male

XNM-TF

XNM-TM

XNF-TF

XNF-TM

Type N: Passivated Stainless Steel / BNC: Nickel Plated Brass BNC Female to N Male BNC Male to N Male BNC Female N Female BNC Male to N Female

XNM-BF

XNM-BM Frequency: DC-18GHz / VSWR: 1.30 max /
XNF-BF Material is Passivated Stainless Steel N Female to SSMA Female

XNF-BM

N Male to SSMA Female

N Male to SSMA Male

N Female to SSMA Male

MDC7905

MDC7911

MDC7906

MDC7912
Material is Passivated or Gold Plated Stainless Steel SSMA Female to SMA Male SSMA Male to SMA Male SSMA Female to SMA Female SSMA Male to SMA Female

MDC3100

MDC3314

MDC3313

MDC3312
BNC: Nickel Plated Brass / SSMA: Passivated Stainless Steel BNC Male to SSMA Female BNC Male to SSMA Male BNC Female to SSMA Female BNC Female to SSMA Male
MDC7903 Dimensions are for reference and subject to change.

MDC7909

MDC7904

MDC7910

INTER SERIES ADAPTERS INTRODUCTION & 2.4 MM, 2.9 MM INTER SERIES
Inter series coaxial adapters are some of the more common components used in RF, microwave and wireless applications. OEMs and manufacturing and engineering test facilities are continually required to provide temporary or permanent connections between the many coaxial series in use. This is particularly true today, where longestablished connector series (N, TNC, BNC, 874, SMA, etc.) must be mated with less common or more recently introduced interfaces (3.5 mm, 2.9 mm, 2.4 mm, 7/16, SSMA, SSMB, SSMC, MCX, MMCX, 7 mm, etc). Recognizing this need, COAXICOM maintains a large inventory of common and not-so-common inter and intra series adapters. This section covers the inter series, while the intra series are shown in the individual connector sections of this catalog. If you have a

requirement not shown in the catalog, please contact the factory for a prompt response. The user should bear in mind that for best performance, the usable frequency range for a given adapter is established by the operating range of the lower frequency interface on the adapter. The recommended frequency range of each connector series is given on the specification sheet within each section. Most adapters are usable at higher frequencies within limitations. COAXICOM manufactures standard and precision adapters. Where applicable, standard adapters use an A suffix in the part number and are usable to frequencies less than 12 GHz for N and TNC, or up to the recommended frequency range for the other series. Most are nickel-plated brass.
Precision adapters feature stainless steel construction for a more precise interface, and an extended frequency range for the N and TNC series. In the case of precision N, TNC or SMAs interfaced with lower frequency series, the precise construction and stepped internal transition yields improved performance beyond the normal operating range of the lower frequency series. NOTES: 1. 75 ohm SMB and SMC type do not mate with the 50 ohm series. 2. 50 and 75 ohm Type N do not mate with each other. 3. 50 and 75 ohm BNC mate without restriction. 4. 50 and 75 ohm TNC mate without restriction. 5. SMA, 3.5 mm and 2.9 mm mate without restriction.
FREQ: DG - 18 GHz VSWR = 1.10 MAX
RECOMMENDED BULKHEAD MOUNTING HOLES
022908-MM TO 2.9 MM JACK 021908-MM TO 2.4 MM JACK

MOUNTING HOLE A

MOUNTING HOLE B
FREQ: DC - 40 GHz VSWR = 1.10 (18 GHz), 1.20 (26.5 GHz), 1.30 (40 GHz)
022100-9 2.9 MM JACK TO 2.4 MM PLUG 022101-9 2.9 MM PLUG TO 2.4 MM JACK 022102-9 2.9 MM JACK TO 2.4 MM JACK 022103-9 2.9 MM PLUG TO 2.4 MM PLUG
7 mm to 2.9 mm and 3.5 mm plugs and jacks are also available. Consult factory. See page 72 for additional choices. 2.4 mm, 2.9 mm and 3.5 mm intra series adapters are also available. Consulty factory.
INTER SERIES ADAPTERS SMA TO N, SSMA, TNC
FREQUENCY: DC-18 GHZ SMA TO SSMA VSWR: 1.30 (MAX)
3313-9 SMA FEMALE TO SSMA FEMALE 3100-9 SMA MALE TO SSMA FEMALE 3312-9 SMA FEMALE TO SSMA MALE 3314-9 SMA MALE TO SSMA MALE
FREQUENCY: DC-18 GHZ N TO SMA VSWR: 1.05 + 007f (GHZ)
3077-9 N MALE TO SMA FEMALE 3080-9 N MALE TO SMA MALE 3098-9 N FEMALE TO SMA FEMALE 3079-9 N FEMALE TO SMA MALE
FREQUENCY: DC-18 GHZ PANEL MOUNT N TO SMA VSWR: 1.05 + 007f (GHZ)
3914-9 N MALE TO SMA MALE 3907-9 N MALE TO SMA FEMALE 3099-9 N FEMALE TO SMA MALE 3081-9 N FEMALE TO SMA FEMALE
FREQUENCY: DC-15 GHZ TNC TO SMA VSWR: 1.04 + 005f (GHZ)
3075-9 TNC MALE TO SMA FEMALE 3078-9 TNC MALE TO SMA MALE 3083-9 TNC FEMALE TO SMA FEMALE 3076-9 TNC FEMALE TO SMA MALE
--17indicates gold plating, indicates nickel plating
- 9 indicates passivated (stainless finish)

For lower frequency applications add A to basic part number. Additional adapters not shown, are usually available from stock. Please contact COAXICOM.
INTER SERIES ADAPTERS SMA, SMB, SMC, BNC, 874

BNC TO SMA

BNC MALE TO SMA FEMALE

BNC MALE TO SMA MALE

BNC FEMALE TO SMA FEMALE

BNC FEMALE TO SMA MALE

SMB TO SMA

SMA FEMALE TO SMB MALE

SMA FEMALE TO SMB FEMALE

SMA MALE TO SMB MALE

SMA MALE TO SMB FEMALE
FREQUENCY DC-10 GHZ SMC TO SMA VSWR 1.04 +.007f (GHZ) MAX.

SMA FEMALE TO SMC MALE

SMA FEMALE TO SMC FEMALE

SMA MALE TO SMC MALE

SMA MALE TO SMC FEMALE

874 TO SMA

3915-TO SMA MALE 3916-TO SMA FEMALE
2524F-7-3 BNC FEMALE TO SMB MALE
BULKHEAD BNC FEMALE TO SMA FEMALE

Mounting Hole A

- 1 indicates gold plating, - 7 indicates nickel plating - 9 indicates passivated (stainless finish)
INTER SERIES ADAPTERS BNC, N, TNC, SMB, SMC (50 ), & 75 SCREW-ON & SNAP-ON

SMB TO SMC

SMB MALE JACK TO SMC MALE JACK
SMB MALE JACK TO SMC FEMALE PLUG
SMB FEMALE PLUG TO SMC FEMALE PLUG
SMB FEMALE PLUG TO SMC MALE JACK
N TO SMB, SMC (50 ), AND 75 SCREW-ON & SNAP-ON
SMC Male Jack SMC Female Plug SMB Male Jack SMB Female Plug 75 Screw-On Male Jack 75 Screw-On Female Plug 75 Snap-On Male Jack 75 Snap-On Female Plug

Suffix

-1 -2 -3 -4 -5 -6 -7 -8

5529- - ( ) N PLUG

5530- - ( ) N BULKHEAD JACK FRONT MOUNT
5556- - ( ) N BULKHEAD PLUG REAR MOUNT

Mounting Hole B

TNC TO SMB, SMC (50 ), AND 75 SCREW-ON & SNAP-ON

4574- - ( ) TNC PLUG

4533- - ( ) TNC BULKHEAD JACK FRONT MOUNT
4564- - ( ) TNC BULKHEAD JACK REAR MOUNT
BNC TO SMB, SMC (50 ), AND 75 SCREW-ON & SNAP-ON

2524- - ( ) BNC PLUG

2525- - ( ) BNC BULKHEAD JACK FRONT MOUNT
2571- - ( ) BNC BULKHEAD JACK REAR MOUNT
- 1 indicates gold plating, - 7 indicates nickel plating These series are nickel-plated brass.
All Suffix 7 and 8 adapters are available as true 75 ohm connectors by adding /75 after basic part number. The

Snap-On side can also be specified as a 75 ohm mini-SMB by adding an M after the 7 or 8 suffix. For example, a true 75 ohm BNC plug to a mini-SMB Snap-On male jack adapter would be a 2524/75-(*)-7M.
INTER SERIES ADAPTERS SSMA & 874 TO BNC & TYPE N

SSMA TO TNC

7913-9 TNC MALE TO SSMA MALE 7907-9 TNC MALE TO SSMA FEMALE 7914-9 TNC FEMALE TO SSMA MALE 7908-9 TNC FEMALE TO SSMA FEMALE

FREQUENCY DC-18 GHZ

7911-9 N MALE TO SSMA MALE 7905-9

SSMA TO N

VSWR 1.30 MAX.
7912-9 7906-9 N FEMALE TO SSMA FEMALE

N MALE TO SSMA FEMALE

N FEMALE TO SSMA MALE

SSMA TO BNC

7909-9 BNC MALE TO SSMA MALE 7903-9 BNC MALE TO SSMA FEMALE 7910-9 BNC FEMALE TO SSMA MALE 7904-9 BNC FEMALE TO SSMA FEMALE

874 TO BNC

2917-TO BNC MALE 2918-TO BNC FEMALE 5919-7

874 TO TYPE N

5920-TO TYPE N FEMALE 874 TO TYPE N MALE
--17 indicates gold plating, indicates nickel plating
For lower frequency applications add A to basic part number. Additional adapters not shown, are usually available from stock. Please contact COAXICOM
INTER SERIES ADAPTERS TNC, 7/16, 3.5 MM, TYPE N, 7 MM
FREQ: DC - 15 GHz VSWR = 1.20
3084PANEL MOUNT TNC FEMALE TO SMA FEMALE
BULKHEAD MOUNT TNC FEMALE TO SMA FEMALE
FREQ: DC - 7.5 GHz VSWR = 1.35
56717/16 MALE TO N FEMALE
56707/16 FEMALE TO N MALE
FREQ: DC - 18 GHz VSWR = 1.20
5908A-9 N FEMALE TO 3.5mm FEMALE 5908-9 N MALE TO 3.5mm FEMALE 5909B-9 N FEMALE TO 3.5mm MALE 5909-9 N MALE TO 3.5mm MALE

5208-75-

5205-75-
BULKHEAD MOUNT N FEMALE TO SMA FEMALE FREQ: DC - 18 GHz VSWR = 1.25
75 OHM N FEMALE TO TYPE F MALE
75 OHM N MALE TO TYPE F FEMALE

SMA MALE TO MCX MALE

DC-18 GHz 7MM INTER SERIES ADAPTERS

Part # a VSWR (max)

1.01 + 0.002f (GHz) 1.01 + 0.002f (GHz) 1.01 + 0.006f (GHz) 1.01 + 0.006f (GHz) 1.035 @ 4 GHz 1.035 @ 4 GHz

SMA FEMALE TO MMCX MALE

SMA MALE TO MMCX FEMALE
N Jack N Plug TNC Jack TNC Plug BNC Jack BNC Plug
3713-9 1.672 3712-9 1.813 3711-9 1.609 3710-9 1.750 2701-9 1.609 2702-9 1.719 3908-9 1.310 3909-9 1.390 7901-9 2.000 7902-9 2.000
1.02 + 0.0025f (GHz) SMA Jack 1.02 + 0.0025f (GHz) SMA Plug 1.01 + 0.005f (GHz) 1.01 + 0.005f (GHz) SSMA Jack SSMA Plug

--19indicates gold plating,(stainless finish) indicates passivated
COMPONENTS TERMINATIONS & ATTENUATORS
DC-18 GHz SMA TERMINATIONS VSWR 1.20:1 MAX.
39001 WATT AVERAGE 1 KW PEAK POWER

3900F-

1 WATT AVERAGE 1 KW PEAK POWER
DC-18 GHz TYPE N TERMINATIONS VSWR 1.25:1 MAX.

5900-9

2 WATTS AVERAGE 1 KW PEAK POWER

5900F-9

3900Q- Quick Connect
THE 3900, 5900, 7900 AND 2900 SERIES ARE AVAILABLE WITH BEAD CHAINS BY ADDING C AT END OF PART NUMBER
DC-30 GHz SSMA TERMINATIONS
7900M0.5 WATT AVERAGE 0.5 KW PEAK POWER

7900F-

0.5 WATT AVERAGE 0.5 KW PEAK POWER
BNC TERMINATIONS DC TO 4 GHz

2900M-7

2 WATTS AVERAGE 0.25 KW PEAK POWER

2900F-7

VSWR: 1.35:1 to 26 GHz, 1.45:1 to 30 GHz
VSWR: 1.15:1 to 3 GHz, 1.20:1 to 4 GHz
SMA MALE 18 GHz TERMINATION 3900-5 AVERAGE POWER 5 W PEAK POWER 2 KW VSWR 1.25:1 MAX. 3900-15 AVERAGE POWER 15 W PEAK POWER 2 KW VSWR 1.35:1 MAX.
TYPE N MALE 18 GHz TERMINATION 5900-5 AVERAGE POWER 5 W PEAK POWER 2 KW VSWR 1.25:1 MAX. 5900-15 AVERAGE POWER 15 W PEAK POWER 2 KW VSWR 1.25:1 MAX.
Add F to Part No. for Female Also Available in BNC and TNC
NOTE: ATTENUATORS AVAILABLE IN ADDITIONAL VALUES THAN THOSE SHOWN. CALL FOR AVAILABILITY. BNC, SMA 50 FEEDTHROUGH TERMINATIONS (2 WATTS) 2989-50BNC: VSWR 1.20:1 FREQUENCY: 500 MHz
3989SMA: VSWR 1.25:1 FREQUENCY: 1 GHz
SMA, TNC ATTENUATORS (2 W AVG.,.25 KW PEAK POWER) 4910-(DB) 3910-(DB) SMA: DC-18 GHz TNC: DC-18 GHz VSWR: 1.35:1 MAX VSWR: 1.35:1 MAX
plating, 1 indicates gold plating, -7 indicates nickel than are -9 indicates passivated (stainless steel) attenuators, terminations, and DC blocks, as Coaxicom manufactures many more components shown. They include 2.9 mm and 7 mm well as GPO attenuators. Additional products include attenuator kits, attenuator/DC Blocks, flange mount attenuators, and Type N to SMA adapter/attenuators. Attenuators and terminations to 300 watts are also available.

75, 100 Also Available

DB L=Length DB 3 +.3.+.+.3.+.+.3.+.75
L=Length.98 max.98 max.98 max
ACCURACY 3 +.3 DB 6 +.3 DB 7-20 +.5 DB 21-30 +.75 DB 40 + 1.0 DB
COMPONENTS ATTENUATORS, PHASE ADJUSTERS, DC BLOCKS, DUST CAPS, SHORTS
NOTE: ATTENUATORS AVAILABLE IN ADDITIONAL VALUES THAN THOSE SHOWN. CALL FOR AVAILABILITY.
DC-18 GHz TYPE N ATTENUATORS VSWR 1.35:1 MAX.

5910-(DB)

5 WATT AVERAGE 0.25 KW PEAK POWER
BNC ATTENUATORS 50 AND 75 OHMS

2910-(DB) / 2910-75-(DB)

1 WATT AVERAGE

PARAMETER

1 KW PEAK POWER

50 OHM 75 OHM

3 + 0.+ 0.+ 0.+ 0.+ 0.+ 1.0 31-60 + 1.5
FREQUENCY DC-2 GHz DC-500 MHZ VSWR MAX. 1.25:1 1.30:1 ACCURACY 3 + 0.3 dB DC-100 MHZ: + 0.2 dB 6 + 0.4 dB 10 + 0.4 dB 20 + 1.0 dB 100-500 MHZ: + 0.5 dB 30 + 1.5 dB
*Also Available in 1.76 Length (up to 30 DB)
2 W 50 , 4 GHz; & 2 W 75 , 2 GHz Avail.
DC-18 GHz PHASE ADJUSTABLE SMA ADAPTERS AND CONNECTORS

3993-1

MALE-FEMALE ADAPTER Part No. 3993A-1 for 4 GHz Unit

3993-2 & 3993-3

3993-2: MALE FOR RG402 SEMIRIGID 3993-3: MALE FOR RG405 SEMIRIGID
SPECIFICATIONS FREQUENCY: DC TO 18 GHz VSWR: 1.30:1 MAX. ADJUSTMENT RANGE: 10X F(GHz) PHASE CHANGE (PER ADJUSTMENT NUT REVOLUTION): 0.636X F(GHz) INSERTION LOSS: ADAPTER: 0.1 X {F(GHz)1/2} dB CONNECTOR:.08 X {F(GHz)1/2} dB VOLTAGE RATING: 500 VRMS DURABILITY: 500 CYCLES TEMPERATURE: -65TO +125C 3993-2: A=.088 3993-3: A=.144
DC-18 GHz SMA DC BLOCK VSWR 1.35:1 MAX. 3985-9 INNER ONLY, 0.5 DB LOSS SMA FEMALE TO SMA MALE 3986-9 INNER, OUTER 0.5 DB LOSS SMA FEMALE TO SMA MALE
DC-18 GHz TYPE N DC BLOCK VSWR 1.35:1 MAX. 5985-9 INNER ONLY, 0.5 DB LOSS N FEMALE TO N MALE 5986-9 INNER, OUTER 0.5 DB LOSS N FEMALE TO N MALE
Also Available in Male/Male, Female/Female
TYPE N MALE DUST CAPS 5230-7 FEMALE AVAILABLE
SMA MALE DUST CAPS 3113WITHOUT CHAIN

SMA MALE SHORT

3230WITH 2.0 BEAD CHAIN

3994M-

Part No. 5113-7 without Chain

3113F=SMA Female

3230F=SMA Female
3994F=Female Add Suffix C for Chain