provider network status
prvdr_ntwk_stsDefinition
ISO-11179 Definition
A coded value indicating the current participation status of a healthcare provider within a specific health plan network, reflecting whether the provider is actively contracted, pending credentialing, suspended, or terminated. Common network status values include active indicating current contracted participation, pending for providers in the credentialing and contracting process, suspended for providers with temporary holds due to quality or compliance issues, and terminated for providers whose contracts have ended. Network status drives claims adjudication to apply correct in-network or out-of-network benefit levels and cost-sharing rules.
Healthcare data teams maintain prvdr_ntwk_sts with effective dates in provider network tables, use status transitions in network adequacy gap analysis, and surface current status in provider directory systems to ensure member-facing directory accuracy.
Standard Abbreviation
prvdr_ntwk_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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