Back to search

claim submission

clm_subm
finance·Updated Jun 13, 2026

Definition

ISO-11179 Definition

The process of transmitting a completed healthcare claim to the appropriate insurance payer for adjudication and payment, using standardized electronic transaction formats or paper claim forms. Electronic claim submission through HIPAA-compliant 837 professional, institutional, or dental transaction sets is required for most Medicare and Medicaid billing and strongly preferred by commercial payers for faster processing and payment. Claims may be submitted directly to payers, through a clearinghouse that validates and routes claims to multiple payers, or through a practice management system with integrated claims submission functionality.

Timely claim submission following charge capture is critical to cash flow management and avoidance of timely filing denials. Healthcare data teams track clm_subm metrics including submission lag days from date of service to submission date, electronic versus paper submission rates by payer, clearinghouse rejection rates identifying systemic claim preparation errors, and same-day submission rates for time-sensitive claim types.

Standard Abbreviation

clm_subm

Category

finance

Production DDL — FACT_CLAIM_TRANSACTION

FACT_CLAIM_TRANSACTION.sql
CREATE OR REPLACE TABLE FACT_CLAIM_TRANSACTION (
    clm_txn_key     INTEGER        NOT NULL  -- surrogate key,
    clm_id          VARCHAR(50)    NOT NULL  -- claim identifier,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    prvdr_key       INTEGER        NOT NULL  -- FK to DIM_PROVIDER,
    clm_typ_cd      VARCHAR(10)              -- claim type code,
    tot_chrg_amt    DECIMAL(18,2)            -- total charged amount,
    tot_alwd_amt    DECIMAL(18,2)            -- total allowed amount,
    tot_pd_amt      DECIMAL(18,2)            -- total paid amount,
    cntrct_adj_amt  DECIMAL(18,2)            -- contractual adjustment,
    denial_ind      CHAR(1)                  -- denial indicator,
    denial_rsn_cd   VARCHAR(10)              -- denial reason code,
    prior_auth_nbr  VARCHAR(30)              -- authorization number,
    clm_lag_days    SMALLINT                 -- claim lag days,
    days_ar         SMALLINT                 -- days in AR,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical finance table. Convert to BigQuery or Databricks →

Why This Term Matters

Healthcare data terminology is foundational for any data engineer working in this industry. Precise understanding of standard terms enables accurate schema design, reduces downstream data quality issues, and ensures pipelines meet the regulatory and interoperability requirements imposed by HIPAA, HL7 FHIR, and CMS reporting frameworks. Without this foundation, even technically well-built pipelines produce data that fails validation when it reaches payers or regulators.

Related Content

Looking for more healthcare terms?

Browse our complete library of 100,000+ standardized healthcare data terms

Browse All Terms