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overpayment

overpmt_amt
finance·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The dollar amount paid by a government or commercial payer to a healthcare provider in excess of the correct payment amount for a claim, which the provider is legally and contractually obligated to identify and return within specified timeframes. Medicare overpayments must be reported and returned within 60 days of identification under the Affordable Care Act, and failure to return identified overpayments within this window converts the overpayment into a false claim with potential treble damage liability. Common sources of overpayments include duplicate claim payments, incorrect fee schedule application, payments for non-covered services, and improper modifier use that generated excess reimbursement.

Healthcare data teams build overpayment detection analytics that identify potential overpayments through payment variance analysis comparing actual payments against correct contracted rates, duplicate payment detection across payer remittances, and systematic review of high-risk billing patterns to proactively identify and return overpayments within compliance timeframes.

Standard Abbreviation

overpmt_amt

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.

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