provider recredentialing
prvdr_recredntl_dtDefinition
ISO-11179 Definition
The periodic re-verification of a healthcare provider qualifications, licensure, certifications, and professional standing required to maintain network participation and clinical privileges in a health plan or healthcare organization. NCQA standards require health plans to recredential providers every three years. Recredentialing includes updated primary source verification of licensure, board certification renewal, malpractice insurance coverage, exclusion and sanction screening, and peer review of clinical performance data.
Providers who fail to complete recredentialing by the due date face network termination until the process is completed. Healthcare data teams build recredentialing tracking systems that calculate due dates three years from initial credentialing approval, generate advance notice workflows at 180, 90, and 30 days before expiration, and monitor completion rates to prevent inadvertent network terminations that would disrupt member care continuity.
Standard Abbreviation
prvdr_recredntl_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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