Back to search

provider medicaid enrollment

prvdr_mcaid_enrl
provider·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The registration and approval process through which a healthcare provider becomes authorized to deliver services to Medicaid beneficiaries and receive reimbursement from state Medicaid programs. Medicaid enrollment is administered by each state Medicaid agency with requirements varying by state, provider type, and service category. Providers must complete state-specific enrollment applications, submit supporting documentation including licensure and tax identification, and pass screening requirements including exclusion checks and site visits for high-risk provider types.

CMS requires states to revalidate Medicaid providers every five years and conduct enhanced screening for moderate and high-risk provider categories. Healthcare data teams build Medicaid enrollment tracking pipelines that monitor enrollment status, revalidation due dates, and enrollment gaps across the provider network to prevent claims payment to unenrolled providers and support state Medicaid audit documentation.

Standard Abbreviation

prvdr_mcaid_enrl

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.

Related Content

Looking for more healthcare terms?

Browse our complete library of 100,000+ standardized healthcare data terms

Browse All Terms