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provider contract type

prvdr_cntrct_typ_cd
provider·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A coded value identifying the category or structure of the contractual arrangement between a healthcare provider and health plan. Common contract types include fee-for-service contracts where providers are paid a negotiated rate per service delivered, capitation contracts where providers receive a fixed monthly payment per assigned member, bundled payment contracts covering an episode of care, shared savings contracts where providers share in cost savings below a benchmark, and global risk contracts where providers accept full financial risk for a defined population. Contract type drives how claims are adjudicated and reimbursed and determines the performance metrics tracked for value-based payment calculations.

Healthcare data teams use prvdr_cntrct_typ_cd in provider master data to route claims to the correct payment logic and in analytics to compare cost and quality outcomes across payment model types.

Standard Abbreviation

prvdr_cntrct_typ_cd

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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