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member chronic condition

mbr_chrnc_cond
member·Updated Jun 23, 2026

Definition

ISO-11179 Definition

An indicator, count, or coded list of chronic medical conditions identified for a health plan member based on claims diagnosis history, pharmacy utilization, or clinical assessment data. Chronic conditions include diabetes, heart failure, chronic obstructive pulmonary disease, hypertension, coronary artery disease, depression, and other long-term health conditions that require ongoing medical management. CMS identifies members with multiple chronic conditions for Medicare Advantage care management program targeting.

Chronic condition status drives HCC risk adjustment coding, HEDIS chronic disease quality measure denominator identification, and care management program eligibility. Healthcare data teams derive mbr_chrnc_cond from claims-based condition algorithms such as the CMS Chronic Conditions Warehouse definitions, maintaining condition flags with evidence dates for longitudinal population health analytics.

Standard Abbreviation

mbr_chrnc_cond

Category

member

Production DDL — DIM_MEMBER

DIM_MEMBER.sql
CREATE OR REPLACE TABLE DIM_MEMBER (
    mbr_key           INTEGER        NOT NULL  -- surrogate key,
    mbr_id            VARCHAR(50)    NOT NULL  -- member identifier,
    mbr_first_nm      VARCHAR(100)             -- first name,
    mbr_last_nm       VARCHAR(100)             -- last name,
    mbr_birth_dt      DATE                     -- date of birth,
    mbr_gndr_cd       CHAR(1)                  -- gender code M/F/U,
    mbr_age           SMALLINT                 -- age in years,
    mbr_state_cd      CHAR(2)                  -- state code,
    mbr_zip_cd        VARCHAR(10)              -- zip code,
    mbr_elig_ind      BOOLEAN                  -- eligibility indicator,
    mbr_enrl_dt       DATE                     -- enrollment date,
    mbr_term_dt       DATE                     -- termination date,
    mbr_plan_cd       VARCHAR(20)              -- plan code,
    mbr_dual_elig_cd  VARCHAR(10)              -- dual eligibility code,
    load_dt           TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

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

Why This Term Matters

Member and enrollment data governs who receives care and who pays for it — making it foundational to every downstream healthcare analytics workflow. Data engineers who understand member terminology build eligibility pipelines that prevent coverage gaps, correctly identify dual-eligible members, and support accurate risk adjustment submissions to CMS. Enrollment errors directly affect capitation payments and can trigger CMS corrective action plans.

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