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provider contract

prvdr_cntrct
provider·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The formal legal agreement between a healthcare provider or provider group and a health plan establishing the terms and conditions of network participation including reimbursement rates, covered services, quality requirements, credentialing standards, utilization management obligations, and dispute resolution processes. Provider contracts define the financial and operational relationship between the parties and are the legal basis for claims payment at negotiated rates. Contract terms typically include base fee schedule rates, value-based payment arrangements, performance bonus eligibility, and risk-sharing provisions.

Healthcare data teams maintain provider contract records with effective dates, contract type, rate schedules, and performance metrics to support claims adjudication at correct contracted rates, contract compliance monitoring, and network management analytics.

Standard Abbreviation

prvdr_cntrct

Category

provider

Production DDL — DIM_PROVIDER

DIM_PROVIDER.sql
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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