provider reimbursement rate
prvdr_reimb_rtDefinition
ISO-11179 Definition
The specific dollar amount or percentage of a reference fee schedule that a health plan pays a contracted healthcare provider for a specific covered service under their network participation agreement. Reimbursement rates are the core financial terms of provider contracts and represent the negotiated balance between provider revenue requirements and health plan cost management objectives. Rates may be expressed as a percentage of Medicare fee schedule, a fixed dollar amount per procedure code, a case rate per admission, a per diem rate per inpatient day, or a capitation amount per member per month.
Healthcare data teams maintain provider reimbursement rate tables with procedure code granularity, effective date ranges, and provider or group identifiers to support accurate claims payment at contracted rates, contract compliance monitoring, and network cost analytics comparing reimbursement levels across provider types and specialties.
Standard Abbreviation
prvdr_reimb_rt
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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