Member

Indicates the member's insurance enrollment status at the time a service charge was incurred, such as active, terminated, or pending. Used in claims adjudication to validate coverage eligibility and determine whether the billed charges are payable under the member's benefit plan.

The specific insurance benefit plan associated with a billed service charge, identifying the coverage structure governing reimbursement. Used in claims processing to apply the correct cost-sharing rules, fee schedules, and network benefit levels when adjudicating the charge.

The unique identifier of the insurance policy under which a billed service charge is submitted for reimbursement. Used in claims processing and billing systems to link individual charges to the correct member coverage record and ensure accurate adjudication.

The member cost-share amount calculated as a percentage of the allowed charge associated with services documented in a medical chart record. Used in risk adjustment and retrospective chart review workflows to reconcile financial responsibility between the health plan and the member.

Indicates the member's health plan enrollment status at the time clinical services were documented in the medical chart, such as active, disenrolled, or suspended. Used in chart review and risk adjustment programs to confirm coverage validity for documented diagnoses and services.

The health benefit plan associated with a member's medical chart record, identifying the coverage under which documented clinical services were rendered. Used in chart review, risk adjustment, and quality reporting programs to align clinical documentation with the correct plan benefit structure.

The insurance policy identifier linked to a member's medical chart record, used to associate clinical documentation with a specific coverage period and benefit plan. Referenced in risk adjustment, quality audits, and retrospective chart review to validate member eligibility for documented services.

The member's cost-share liability, calculated as a percentage of the allowed amount, for laboratory chemistry panel services such as metabolic panels or lipid tests. Captured in claims and remittance data to determine patient financial responsibility for outpatient or inpatient lab chemistry charges.

Indicates the member's insurance enrollment status at the time laboratory chemistry services were ordered or performed, confirming active coverage for the associated lab tests. Used in claims adjudication to validate eligibility before processing reimbursement for chemistry panel charges.

The insurance benefit plan under which laboratory chemistry services are billed and reimbursed, governing coverage rules for tests such as comprehensive metabolic panels. Used in claims processing to apply the correct network rates, prior authorization requirements, and cost-sharing terms.

The unique insurance policy identifier associated with a claim for laboratory chemistry services, linking the lab test charges to the member's active coverage record. Used in claims adjudication and lab billing systems to ensure chemistry panel services are correctly attributed to the responsible payer.

A flag indicating whether a coinsurance cost-sharing requirement is currently active for a member's benefit plan. Used in claims adjudication and member benefits configuration to determine whether percentage-based cost sharing should be applied when calculating patient liability for covered services.

Indicates whether a coinsurance rule or benefit tier is currently active within a member's health plan. Used in benefits administration to determine if a specific cost-sharing percentage applies to claims processing, eligibility verification, and remittance calculations.

Captures the member's age at the time a coinsurance benefit rule is applied or evaluated. Used in health plan benefits configuration where age-banded cost-sharing percentages differ across member populations, influencing claims adjudication and benefit determination workflows.

The maximum dollar amount a health plan permits for a covered service before applying the member's coinsurance percentage. Drives cost-sharing calculations during claims adjudication, determining the member's out-of-pocket liability and the plan's reimbursement obligation.

The calculated dollar amount representing the member's percentage-based cost-share obligation after deductible satisfaction, stored as coins_amt in claims adjudication and PBM systems. Used in EOB generation, member liability reporting, accumulator tracking, and downstream financial analytics across medical and pharmacy benefit platforms.

Tracks whether a coinsurance benefit rule, rate change, or cost-sharing configuration has been formally authorized within the health plan's benefits administration system. Used in plan setup workflows to ensure coinsurance terms are validated before being applied to claims.

Identifies the user, role, or system that authorized a coinsurance benefit configuration or rate change within the health plan administration platform. Supports audit trail requirements and change management controls for cost-sharing benefit structures in insurance operations.

Records the timestamp when a coinsurance-related transaction, claim, or benefit record was received or entered into the health plan processing system. Used to support service-level tracking, adjudication sequencing, and operational reporting within claims or benefits workflows.

Records the calendar date when a coinsurance-related claim, transaction, or benefit configuration record was received by the health plan. Used to establish processing timelines, measure adjudication turnaround, and support audit and compliance reporting in insurance operations.