provider fee schedule
prvdr_fee_schdDefinition
ISO-11179 Definition
The schedule of maximum allowable payment amounts for covered healthcare services established by a health plan or government payer for reimbursing contracted providers. Fee schedules define the allowed amount for each procedure code, modifier combination, and place of service, representing the maximum the payer will pay regardless of the provider billed charges. Medicare fee schedules are published annually by CMS in the Medicare Physician Fee Schedule Final Rule and are updated with geographic practice cost index adjustments for each payment locality.
Commercial health plans negotiate fee schedules with providers as a percentage of Medicare rates or independently negotiated amounts. Healthcare data teams maintain fee schedule tables with effective date ranges, procedure codes, geographic modifiers, and allowed amounts to support claims adjudication at correct contracted rates and fee schedule analytics comparing reimbursement levels across the provider network.
Standard Abbreviation
prvdr_fee_schd
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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