Operations

The professional license identifier that is valid and active as of the coverage or enrollment start date. Used in credentialing and provider data systems to confirm a clinician's licensure status aligns with the period during which services were rendered or credentials were verified.

The member's relationship status that is active as of the coverage effective date. Used in member enrollment and eligibility systems to determine dependency eligibility, premium tier assignment, and benefit coordination rules applicable during a specific enrollment period.

The enterprise master person or entity identifier that is active as of the coverage start date. Used in master data management systems to link records across disparate healthcare platforms, ensuring consistent identity resolution for members, patients, or entities throughout a defined effective period.

The upper limit threshold that is active as of the coverage start date. Used in benefit administration and claims processing to define the maximum allowable benefit amount, service quantity, or reimbursement cap applicable to a member during a specific coverage period.

The patient medical record number that is active and valid as of the coverage or encounter start date. Used in clinical and enrollment systems to ensure accurate patient identification and record linkage when a patient's MRN may have changed due to system migrations or facility mergers.

The middle name or initial associated with a member, patient, or entity that is active as of the coverage start date. Used in enrollment and eligibility systems to support accurate identity matching and distinguish individuals who share the same first and last name within a health plan or clinical system.

The lower limit threshold that is active as of the coverage start date. Used in benefit administration and claims adjudication to define the minimum allowable benefit amount, service quantity, or cost-sharing floor applicable to a member during a specific coverage or contract period.

The mobile phone number that is active and valid as of the coverage start date. Used in member enrollment and care management systems to support outreach, appointment reminders, and two-factor authentication during the period in which the contact information was recorded as current.

The user identifier of the individual who last updated the record as of the coverage effective date. Used in audit trail and data governance processes within enrollment and claims systems to track accountability for changes made to effective-dated records during a specific period.

The calendar date on which an effective-dated record was last updated. Used in enrollment, claims, and eligibility systems to maintain an accurate audit history, ensuring that changes to coverage terms, member demographics, or benefit parameters are traceable to a specific modification event.

The timestamp indicating when an effective-dated record was last updated. Used alongside the modified date in enrollment and eligibility systems to provide precise audit trail information, supporting data reconciliation and compliance reviews when multiple changes occur within the same calendar day.

The display name or label that is active as of the coverage start date. Used in member enrollment, plan administration, and reporting systems to present the correct name for a member, benefit plan, or entity during the period in which that name was formally recorded as current.

The annotation or free-text comment associated with a record that is active as of the coverage effective date. Used in enrollment and care management systems to capture contextual information, exceptions, or processing instructions relevant to a member's coverage or clinical status during a defined period.

The reference number associated with a record or transaction that is valid as of the coverage start date. Used in claims, enrollment, and eligibility systems to track and cross-reference specific benefit plans, authorizations, or member accounts that were active during a particular coverage period.

The date on which a condition, symptom, or clinical event first appeared, recorded as active within the context of a coverage or encounter period. Used in clinical documentation and claims processing to establish medical necessity, coordinate benefits, and determine whether a condition predates coverage enrollment.

The blood oxygen saturation level recorded as clinically active during a specific coverage or encounter period. Used in clinical documentation and remote patient monitoring systems to track a patient's respiratory status over time, supporting treatment decisions and chronic condition management within a defined care episode.

The payment amount that was disbursed and recognized as valid as of the coverage effective date. Used in claims adjudication and financial reconciliation systems to record the actual dollar amount paid to a provider or member for services rendered during a specific benefit period, net of adjustments.

The date on which a payment was issued and recorded as valid within the coverage period. Used in claims processing and financial reporting systems to confirm when reimbursement was disbursed to a provider or member, supporting remittance reconciliation and cash flow analysis for a specific benefit period.

The superior or owning entity in a hierarchical relationship that is active as of the coverage start date. Used in plan administration, organizational, and benefit structure systems to identify which parent plan, group, or entity governs a subordinate record's rules, eligibility criteria, or cost-sharing terms during a defined period.

The percentage rate or ratio value active as of the coverage effective date, such as a coinsurance rate, cost-sharing percentage, or benefit utilization rate applied to insurance claims processing and member benefit calculations during the active enrollment period.