provider billing code
prvdr_bill_cdDefinition
ISO-11179 Definition
The procedure code used by a healthcare provider on a claim to identify the specific service or supply delivered to a patient, drawn from standardized code sets including CPT for physician services, HCPCS Level II for drugs and supplies, ICD-10-PCS for inpatient procedures, and CDT for dental services. Billing codes are the primary driver of claims payment amounts and are subject to extensive editing rules that validate code validity, medical necessity, code bundling restrictions, and provider type appropriateness. Upcoding, unbundling, and billing for services not rendered are leading categories of healthcare fraud involving manipulation of billing codes.
Healthcare data teams build claims editing pipelines that validate prvdr_bill_cd against current code sets, apply CCI edits for bundled services, check code-to-specialty consistency, and flag anomalous billing patterns for fraud detection and payment integrity analytics.
Standard Abbreviation
prvdr_bill_cd
Category
Production DDL — DIM_PROVIDER
CREATE OR REPLACE TABLE DIM_PROVIDER (
prvdr_key INTEGER NOT NULL -- surrogate key,
prvdr_npi VARCHAR(10) -- NPI number,
prvdr_tin VARCHAR(10) -- tax ID number,
prvdr_first_nm VARCHAR(100) -- first name,
prvdr_last_nm VARCHAR(100) -- last name,
prvdr_org_nm VARCHAR(255) -- organization name,
prvdr_typ_cd VARCHAR(20) -- provider type code,
prvdr_spclty_cd VARCHAR(10) -- specialty code,
prvdr_tax VARCHAR(10) -- taxonomy code,
prvdr_state_cd CHAR(2) -- state code,
prvdr_zip_cd VARCHAR(10) -- zip code,
prvdr_ntwk_sts VARCHAR(10) -- network status,
prvdr_accpt_pt_ind CHAR(1) -- accepting patients,
prvdr_excl_ind CHAR(1) -- exclusion indicator,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical provider table. Convert to BigQuery or Databricks →
Why This Term Matters
Provider data management is one of the most operationally complex data domains in healthcare because providers move, merge, and update their credentials continuously. A data engineer who understands provider terminology can build NPI validation, credentialing, and network adequacy pipelines that keep provider directories accurate and prevent claim rejections. Stale or incorrect provider data is a leading cause of prior authorization delays and CMS compliance findings.
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