Claims

The complete name of the patient or associated individual on the referral record, combining all name components. Used in referral management and care coordination systems for patient identification, communication generation, and matching records across clinical and administrative data sources.

The gender of the patient associated with a referral record as captured at the time of referral creation. Used in care coordination systems to ensure clinical appropriateness of specialist referrals, support demographic reporting, and comply with health equity data collection standards in managed care.

The blood glucose measurement recorded in connection with a patient referral, typically supporting referrals to endocrinology or diabetes management programs. Captured as clinical context to inform the receiving specialist of metabolic status and support risk stratification in chronic disease care coordination.

The insurance plan group identifier associated with the member's coverage at the time a referral is issued. Used in authorization and claims processing systems to link the referral to the correct benefit plan, verify eligibility, and ensure services are adjudicated under the appropriate group contract.

The hemoglobin measurement recorded in association with a patient referral, commonly used when directing patients to hematology, nephrology, or oncology services. Provides clinical context to the receiving specialist and supports medical necessity documentation within care coordination and authorization workflows.

Unique system-generated key assigned to a specialist referral request in EHR, managed care, or claims platforms. Links authorization records to associated claims, member eligibility, and provider data across adjudication, reporting, and care coordination workflows.

Positional sequence number assigned to a referral within a member's authorization history or within a batch referral transaction set. Used in managed care and EHR systems to order multiple referrals for the same member, episode, or provider relationship.

Yes/no field denoting whether a referral was obtained prior to a specialist visit or procedure. Present in claims, managed care, and encounter data systems to support HMO compliance auditing, quality reporting, and utilization management analytics for data engineers.

The primary surrogate key uniquely identifying a referral record within the referral management or authorization system. Used as the foundational join field across related tables in claims, utilization, and care coordination data models to link referral details to encounters, authorizations, and member records.

The preferred spoken or written language of the patient associated with a referral, used to ensure appropriate communication and interpreter services are arranged between the referring provider, receiving specialist, and patient during care coordination.

The family surname of the patient named in a referral authorization record, used to match the referral to the correct member enrollment record and verify patient identity when scheduling specialist appointments or processing referral-linked claims.

The full legally registered name of the patient on a referral record, used for identity verification against health plan enrollment data, insurance claims, and medical records to ensure accurate attribution of specialist services and authorizations.

Hierarchical classification of a referral indicating its scope, urgency tier, or authorization complexity within managed care workflows. Used in utilization management and EHR systems to distinguish standard, urgent, or expedited referrals for processing and reporting.

The state-issued professional license number of the referring or receiving provider associated with a referral transaction, used to validate provider credentials, confirm network participation, and support regulatory compliance in utilization management workflows.

The marital status of the patient at the time a referral is issued, captured in member enrollment and referral management systems to support demographic reporting, coordination of benefits determinations, and dependent coverage verification for specialist visits.

The enterprise-level unique identifier assigned to a referral record across all connected health systems, used to link referral authorizations, claims, clinical notes, and utilization management data to a single patient referral event without duplication.

The upper limit on the number of authorized visits, services, or dollar amount approved within a referral authorization, used by health plans and utilization management teams to enforce benefit limits and prevent overpayment on specialist or ancillary care.

The middle name or initial of the patient identified in a referral record, used alongside first and last name to disambiguate patients with similar names during identity matching across referral authorization, claims, and member enrollment systems.

The minimum number of visits or service units that must be fulfilled under a referral authorization before it is considered active or valid, used in utilization management to set care thresholds and ensure appropriate specialist engagement for the patient.

The mobile phone number of the patient associated with a referral record, used by care coordination and scheduling teams to confirm specialist appointments, send authorization status notifications, and support outreach efforts tied to the referral.