Member

A reference identifier assigned by an external system, such as a clearinghouse or trading partner, to a coinsurance cost-sharing record. Enables cross-system reconciliation of member cost-sharing data between health plans, TPAs, and downstream claims processing platforms.

The facsimile number associated with the entity or contact linked to a coinsurance benefit record. Used in health plan administration workflows to transmit coinsurance-related documents such as benefit summaries or cost-sharing notices to members or facilities.

The specific monetary charge or applied cost associated with a coinsurance benefit calculation. Used in claims adjudication to capture the dollar amount a member owes based on their cost-sharing percentage after the health plan's portion of the allowed amount is applied.

The given name of the member or individual associated with a coinsurance cost-sharing record. Used in health plan enrollment and claims systems to identify the specific enrollee responsible for the cost-sharing percentage applied to covered medical services.

A Boolean indicator field stored as coins_flg that denotes whether a coinsurance cost-share obligation applies to a specific pharmacy claim or transaction. Used in PBM adjudication logic, benefit plan configuration validation, and downstream pharmacy analytics to filter and segment cost-sharing records accurately.

Defines how often a coinsurance cost-sharing obligation applies within a benefit period, such as per visit, per admission, or per service type. Used in health plan benefit configuration to control when and how frequently member cost-sharing percentages are triggered during claims adjudication.

The complete name of the member or enrollee associated with a coinsurance cost-sharing benefit record. Used in health plan administration and member communications to accurately identify individuals subject to specific cost-sharing percentage rules within their insurance plan.

Records the gender of the member or enrollee linked to a coinsurance cost-sharing record. Used in health plan analytics, population health reporting, and benefits administration to support demographic-based analysis of cost-sharing patterns across insured populations.

Records a blood glucose clinical measurement associated with a member's coinsurance-covered service encounter. Used in disease management and value-based care programs to link clinical lab results to the cost-sharing obligations applied when diabetes-related services are adjudicated.

The insurance group plan identifier associated with a coinsurance cost-sharing record. Used in claims adjudication and member enrollment systems to link an individual member's cost-sharing percentage to the specific employer or sponsor group plan under which coverage is provided.

Records a hemoglobin clinical measurement associated with a member's coinsurance-covered service encounter. Used in chronic disease management programs to correlate lab results with cost-sharing obligations when hematology-related services are processed through claims adjudication.

A unique system-generated or plan-assigned key stored as coins_id that links a coinsurance transaction to a specific claims adjudication record within healthcare claims processing systems. Used for referential integrity, audit tracing, cost-share reconciliation, and integration between payer, PBM, and downstream analytics platforms.

A numeric position or sequence value assigned to a coinsurance record within a benefit plan structure. Used in health plan data systems to order and reference multiple coinsurance tiers or cost-sharing rules that apply across different service categories or benefit periods.

A coded field stored as coins_ind that signals the presence, type, or applicability of a coinsurance cost-share requirement on a pharmacy claim or benefit record. Used in PBM adjudication engines and benefit configuration systems to trigger appropriate member liability calculations and plan design rule enforcement.

Free-text or coded guidance associated with how a coinsurance cost-sharing rule should be applied during claims processing. Used in health plan benefit configuration to communicate special handling requirements or exceptions to claims adjudicators when calculating member cost-sharing obligations.

A system-generated or assigned lookup value used to uniquely reference a coinsurance cost-sharing rule within a benefits database. Used in health plan and claims systems to retrieve and apply the correct cost-sharing percentage when adjudicating member claims for covered services.

Records the preferred communication language of the member associated with a coinsurance cost-sharing record. Used in health plan member services to ensure that cost-sharing explanations, benefit summaries, and Explanation of Benefits documents are delivered in the member's preferred language.

The family surname of the member or enrollee associated with a coinsurance cost-sharing benefit record. Used in health plan enrollment and claims systems to identify and verify the individual responsible for the cost-sharing percentage applied to their covered medical services.

The officially registered legal name of the member or enrollee tied to a coinsurance cost-sharing record. Used in health plan enrollment and compliance workflows to ensure accurate identification for benefit eligibility verification, claims adjudication, and regulatory reporting purposes.

Business attribute for coinsurance within Clinical processes in Healthcare implementations. Used for reporting, integrations, and downstream analytics.