Back to search

performance benchmark

perf_bnchmark_amt
finance·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A reference standard or target value representing the expected level of performance against which actual healthcare cost, quality, or utilization results are compared to determine payment adjustments in value-based care contracts, shared savings programs, and quality bonus arrangements. Performance benchmarks may be established based on historical expenditure trends adjusted for risk and market factors, regional or national peer comparisons, absolute performance thresholds defined in contract terms, or improvement targets measuring progress from a baseline period. CMS establishes Medicare Shared Savings Program benchmarks using three years of historical Medicare expenditure data for assigned beneficiaries, adjusted for risk score changes and national trend factors.

Healthcare data teams model perf_bnchmark_amt calculations using CMS methodology and commercial contract terms, track actual performance against benchmark throughout the measurement period, analyze the drivers of benchmark deviation including care pattern changes and risk score shifts, and project final benchmark performance to support proactive care management interventions that improve the likelihood of achieving shared savings.

Standard Abbreviation

perf_bnchmark_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.

Related Content

Looking for more healthcare terms?

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

Browse All Terms