eligibility procedure date
elig_proc_dtDefinition
ISO-11179 Definition
The date a specific medical procedure was performed that is associated with a member's insurance coverage eligibility determination. Used in member enrollment and claims adjudication systems to verify that procedures occurred within active coverage windows and to support prior authorization or benefit coordination reviews.
Standard Abbreviation
elig_proc_dt
Category
Production DDL — FACT_CLINICAL_EVENT
CREATE OR REPLACE TABLE FACT_CLINICAL_EVENT (
clin_evt_key INTEGER NOT NULL -- surrogate key,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
prvdr_key INTEGER NOT NULL -- FK to DIM_PROVIDER,
diag_cd VARCHAR(10) -- ICD-10 diagnosis code,
hcc_cd VARCHAR(10) -- HCC category code,
proc_cd VARCHAR(10) -- procedure code,
svc_dt DATE -- service date,
pos_cd VARCHAR(2) -- place of service,
raf_scr DECIMAL(10,3) -- RAF score,
admit_dt DATE -- admission date,
dsch_dt DATE -- discharge date,
drg_cd VARCHAR(10) -- DRG code,
los_days SMALLINT -- length of stay,
readmt_ind CHAR(1) -- readmission indicator,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical clinical table. Convert to BigQuery or Databricks →
Why This Term Matters
Clinical terms are the building blocks of risk adjustment, quality measurement, and value-based care analytics. A data engineer who understands this terminology can design schemas that correctly capture patient conditions, procedures, and encounters — enabling accurate HCC scoring, HEDIS measure attribution, and CMS reporting. Misclassifying clinical fields in a data warehouse cascades into incorrect RAF scores and failed regulatory submissions.
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