Domain
Enrollment, eligibility, demographics and plan attribution
2,833 member terms
The defined time interval during which coinsurance accumulations and cost-sharing obligations are tracked and applied for a member's health plan benefit. Typically aligned with a plan year or benefit year for deductible and out-of-pocket maximum calculations.
The primary telephone number of the member or subscriber associated with a coinsurance cost-sharing record. Used for member contact and billing communications related to outstanding or processed coinsurance obligations within health plan member services.
The health plan or benefit plan associated with a specific coinsurance cost-sharing rule. Identifies the insurance product under which the coinsurance terms apply and links the coinsurance configuration to the applicable plan documents and benefits structure.
Identifies the specific insurance policy under which a coinsurance arrangement applies. Used in claims adjudication to link member cost-sharing obligations to the correct benefit plan, ensuring accurate calculation of the member's percentage-based out-of-pocket liability after deductible is met.
The standardized display label assigned to a coinsurance benefit tier or plan structure. Used in member-facing materials, explanation of benefits documents, and billing systems to present the cost-sharing arrangement in a clear, human-readable format that aligns with plan branding.
The dollar amount representing the member's coinsurance obligation for a specific covered service after the deductible has been satisfied. Derived from applying the plan's cost-sharing percentage to the allowed amount on a medical or pharmacy claim during adjudication.
A flag designating whether a coinsurance arrangement is the primary cost-sharing rule applied during claims adjudication. Used in coordination of benefits processing to determine which plan's coinsurance terms are applied first when a member holds coverage under multiple insurance plans.
A numeric ranking that determines the order in which coinsurance rules are applied when multiple cost-sharing tiers or benefit layers exist within a plan. Used during claims adjudication to sequence the application of member liability calculations across primary and secondary coverage.
A metric tracking the frequency or activity level of coinsurance transactions within a defined period. Used in benefit plan analytics to monitor the rate at which member cost-sharing obligations are triggered across claims, supporting utilization review and plan performance reporting.
The count of services, units, or claim lines subject to coinsurance cost-sharing within a benefit period. Used in member liability calculations and plan analytics to quantify how many billable events generated a coinsurance obligation under the applicable insurance policy.
Captures the racial demographic classification of the member associated with a coinsurance transaction. Used in health equity analytics to identify disparities in cost-sharing burdens across racial groups, supporting population health reporting and compliance with equity mandates.
The percentage of an allowed claim amount that the member is responsible for paying after the deductible is met. Defined in the benefit plan design and applied during claims adjudication to calculate member out-of-pocket liability for covered medical, facility, or pharmacy services.
An actuarial or underwriting assessment value assigned to a coinsurance structure based on plan risk, member demographics, or utilization patterns. Used in premium pricing and benefit design decisions to evaluate the financial exposure associated with a specific coinsurance percentage.
The proportional relationship between the member's coinsurance payment and the total allowed amount for a covered service. Used in financial reporting and benefit analysis to measure the split of cost responsibility between the health plan and the member across claim populations.
Reason descriptor for coinsurance within Utilization processes in Healthcare implementations. Used for reporting, integrations, and downstream analytics.
The date on which a coinsurance payment was received from the member or secondary payer. Used in accounts receivable tracking, claim reconciliation, and member billing workflows to confirm that the member's cost-sharing obligation has been collected and applied correctly.
An external identifier or cross-system pointer linking a coinsurance transaction to a related claim, remittance advice, or benefit plan record. Used in claims reconciliation and audit workflows to trace member cost-sharing obligations across multiple healthcare administrative systems.
The date on which a coinsurance liability was fully resolved, either through member payment, adjustment, or write-off. Used in accounts receivable management and claims auditing to measure collection cycle times and close outstanding member cost-sharing obligations in billing systems.
A system health or processing throughput metric indicating the rate at which coinsurance calculations are executed within claims adjudication pipelines. Used in operational monitoring to assess the performance and stability of cost-sharing computation processes across high-volume claim batches.
The version or iteration number reflecting updates made to a coinsurance rule, benefit structure, or member liability record. Used in audit trails and benefit administration systems to track changes to cost-sharing terms over time and ensure accurate retroactive claims adjustments.