provider credentialing status
prvdr_credntl_stsDefinition
ISO-11179 Definition
A coded value indicating the current stage or outcome of a healthcare provider credentialing process within a health plan or healthcare organization credentialing workflow. Common credentialing status values include application received for providers who have submitted initial paperwork, pending verification for applications in active primary source verification, pending committee review for completed files awaiting medical staff or credentialing committee approval, approved for providers who have completed credentialing and been granted network participation, denied for applications that did not meet credentialing standards, and expired for providers whose credentialing period has lapsed without recredentialing completion. Healthcare data teams use prvdr_credntl_sts in provider network management systems to track pipeline volume, identify bottlenecks in the credentialing workflow, prevent premature network activation before approval, and generate compliance reports for NCQA credentialing accreditation surveys.
Standard Abbreviation
prvdr_credntl_sts
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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