provider network effective date
prvdr_ntwk_eff_dtDefinition
ISO-11179 Definition
The date on which a healthcare provider network participation agreement becomes active, establishing the start of the contracted relationship between the provider and health plan. The network effective date determines when claims for services rendered by the provider are eligible for in-network benefit levels and contracted reimbursement rates. Retroactive network effective dates may be applied during credentialing delays to ensure members who received care during the credentialing period are not penalized with out-of-network cost sharing.
Healthcare data teams use prvdr_ntwk_eff_dt as the start boundary in point-in-time network status queries, joining service dates against network effective and termination dates to determine the correct network participation status at the time of care for accurate claims adjudication and member cost-sharing calculation.
Standard Abbreviation
prvdr_ntwk_eff_dt
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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