provider contract rate
prvdr_cntrct_rtDefinition
ISO-11179 Definition
The negotiated reimbursement amount specified in a provider network participation contract for a defined service, procedure, or payment unit, representing the agreed financial terms between a healthcare provider and health plan. Contract rates may differ from the fee schedule allowed amount when providers have negotiated rates above or below the standard fee schedule through individual contract negotiations. Large hospital systems and dominant specialty groups often negotiate rates significantly above Medicare rates while smaller independent providers may accept closer to Medicare-equivalent rates.
Contract rate data is commercially sensitive and closely guarded by both providers and payers. Healthcare data teams use prvdr_cntrct_rt in claims adjudication to ensure payment accuracy, in contract modeling to project network cost impact of rate changes, and in actuarial analysis to calculate medical loss ratio and premium adequacy.
Standard Abbreviation
prvdr_cntrct_rt
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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