Member

Captures evaluative notes or determinations made during review of a coinsurance benefit rule, dispute, or cost-sharing calculation. Used in health plan operations to document findings when auditing member cost-sharing liability, benefit configuration accuracy, or claim payment outcomes.

Represents the remaining member financial obligation after payments have been applied toward the coinsurance portion of a claim. Tracked in health plan billing and member accounts to reflect unpaid cost-sharing amounts and support collections, statements, and payment reconciliation.

The total dollar amount submitted by a provider on a claim before insurance adjudication and cost-sharing calculations are applied. Serves as the starting value from which allowed amounts, contractual adjustments, and the member's coinsurance responsibility are derived during claims processing.

Records the member's date of birth as used in evaluating age-dependent coinsurance benefit rules within a health plan. Ensures accurate application of age-banded cost-sharing tiers during eligibility verification, claims adjudication, and benefit period calculations.

Captures a member's blood pressure reading as associated with a clinical encounter that triggered a coinsurance-applicable claim. Used in value-based or condition-specific benefit programs where clinical metrics may influence cost-sharing determinations or wellness benefit eligibility.

Records the date on which a coinsurance benefit rule, rate configuration, or cost-sharing tier was formally deactivated or voided within the health plan administration system. Used to manage benefit effective date ranges and ensure accurate claims adjudication after plan changes.

Classifies a coinsurance rule into a defined benefit grouping such as in-network, out-of-network, specialist, or preventive care. Used in health plan benefit design and claims adjudication to apply the correct cost-sharing percentage based on service type and coverage tier.

The specific dollar amount charged to the member as their coinsurance responsibility for a covered service after the plan's allowed amount and any deductible obligations have been satisfied. Calculated during claims adjudication and reflected on the member's explanation of benefits.

Documents the primary clinical reason or diagnosis associated with a service encounter for which a coinsurance obligation was generated. Used in health plan analytics to link member cost-sharing liability to specific conditions or service categories for utilization and population reporting.

Identifies a dependent or subordinate coinsurance benefit record linked to a parent plan or policy configuration. Used in family benefit structures where individual member cost-sharing rules are derived from or nested within a primary subscriber's health plan coinsurance terms.

Captures the city associated with a member or service location relevant to a coinsurance benefit record. Used in health plan administration to support geographic rating, network assignment, and regional benefit configuration that may influence applicable cost-sharing percentages.

Denotes the benefit classification tier assigned to a coinsurance rule, such as primary, secondary, or supplemental coverage class. Used in health plan coordination of benefits and claims adjudication to determine which cost-sharing percentage applies based on coverage hierarchy and plan design.

Standardized code for coinsurance within Compliance processes in Healthcare implementations. Used for reporting, integrations, and downstream analytics.

The calculated dollar value representing the member's share of costs under a coinsurance arrangement, derived by applying the plan's cost-sharing percentage to the allowed amount of a covered service. This figure directly determines member out-of-pocket liability on an explanation of benefits.

Free text notation field capturing supplemental information about a member's coinsurance cost-sharing percentage within a benefit plan. Used in member enrollment and claims processing to document exceptions, special arrangements, or clarifying notes about the applicable coinsurance rate.

The date on which the coinsurance cost-sharing arrangement or associated process was finalized within the benefit plan configuration. Used in member enrollment systems to track when coinsurance terms were fully established, modified, or closed for a specific coverage period.

A flag indicating whether a member's coinsurance cost-sharing details are subject to confidentiality restrictions within the health plan. Used in member enrollment and benefits administration to control access to sensitive cost-sharing information in compliance with privacy regulations.

A numeric aggregation field representing the total number of coinsurance transactions or events within a defined billing period in healthcare implementations. Stored as coins_cnt, this value supports billing reconciliation, provider remittance reporting, and cost-share analytics in claims and revenue cycle management systems.

The country associated with a coinsurance cost-sharing arrangement, used to apply jurisdiction-specific benefit rules and cost-sharing calculations. Relevant in health plan administration for members with international coverage or plans subject to country-specific regulatory requirements.

The unique identifier of the user or system that originally created the coinsurance cost-sharing record within the benefits administration or member enrollment system. Used for audit trail purposes to track accountability and data lineage of benefit plan configuration changes.