Claims

The family surname of the individual associated with an eligibility or identity verification record. Used as a primary demographic matching field when validating member identity against payer enrollment files and confirming insurance coverage during patient intake or claims processing.

The officially registered legal name of the individual as recorded in payer enrollment or government identification records. Used during eligibility verification to resolve discrepancies between preferred names and official documentation, supporting accurate claims submission and identity validation.

Indicates the depth or tier of an eligibility verification check, such as basic coverage confirmation versus detailed benefits breakdown. Used in payer and revenue cycle systems to distinguish between summary-level and comprehensive 270/271 EDI transaction responses returned for a given member.

The state-issued professional license number associated with a credentialing or provider identity verification record. Used during payer credentialing and enrollment processes to confirm that a clinician holds a valid, active license before approving participation in a health plan network.

The marital or domestic relationship status of a member captured during an eligibility verification transaction. Used by payers and enrollment systems to determine dependent coverage eligibility, coordinate benefits between spouses, and apply correct plan benefit rules during claims adjudication.

The enterprise master person or member index identifier associated with a verification record, used to link eligibility transactions to a single longitudinal member record across multiple payer systems, data warehouses, and health information exchanges for deduplication and unified member management.

The upper benefit limit value returned as part of an eligibility verification response, such as maximum annual out-of-pocket costs or maximum covered service units. Used by billing and utilization management teams to determine member cost exposure and remaining benefit availability.

The facility-assigned medical record number linked to a patient during an eligibility verification transaction. Used to reconcile payer-confirmed insurance coverage with the patient's clinical record in hospital or ambulatory EHR systems, ensuring accurate billing and encounter documentation.

The middle name or initial of the individual associated with an eligibility or identity verification record. Used as a supplementary demographic matching field to disambiguate members with common first and last names during payer enrollment validation and insurance coverage confirmation.

The lower benefit threshold value returned during an eligibility verification response, such as minimum deductible amounts or minimum service quantities covered under a health plan. Used by revenue cycle teams to calculate member financial responsibility and establish payment estimates at the time of service.

The mobile phone number associated with a member captured during an eligibility or identity verification transaction. Used to support real-time eligibility notifications, appointment reminders, and follow-up communications related to coverage confirmation or outstanding authorization requirements.

Identifies the user who last updated a verification record in healthcare systems. Captures the username or user ID of the individual who modified eligibility, benefit, or clinical verification data, supporting audit trails and accountability in compliance workflows.

Records the calendar date when a verification record was last updated in healthcare systems. Used in eligibility verification, prior authorization, and benefit confirmation workflows to track when changes occurred and support audit compliance and data integrity reviews.

Records the exact time a verification record was last updated in healthcare systems. Combined with the modified date, provides a precise timestamp for changes to eligibility, benefit, or prior authorization verifications, supporting audit trails and system reconciliation.

The human-readable label assigned to a specific verification record or verification type in healthcare systems. Used to identify and display eligibility checks, benefit verifications, or prior authorization confirmations in administrative workflows and reporting interfaces.

Free-text annotation field capturing supplemental information about a verification record in healthcare systems. Used to document details from eligibility checks, prior authorization decisions, or benefit confirmations that are not captured in structured data fields, supporting claims and enrollment workflows.

Unique reference number assigned to a specific verification transaction in healthcare systems. Used to track and retrieve eligibility checks, prior authorizations, or benefit confirmations across payer, provider, and clearinghouse systems, enabling cross-system reconciliation and status lookup.

Records the date when a verified condition, benefit, or eligibility period began. Used in clinical and claims workflows to establish the start of a verified diagnosis, coverage term, or authorized service period, supporting medical necessity determinations and claims adjudication accuracy.

The blood oxygen level for a correctness confirmation. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for verification management and reporting.

Captures the actual dollar amount paid as confirmed through a verification process in healthcare billing systems. Used in claims reconciliation to record the verified payment received for a service, supporting accounts receivable management and payer contract compliance tracking.