provider star rating
prvdr_star_rtgDefinition
ISO-11179 Definition
A summary quality rating displayed in health plan provider directories and consumer-facing tools representing a healthcare provider overall performance on quality, patient experience, and efficiency measures, typically expressed as a one to five star scale. Provider star ratings are derived from composite quality scores and are increasingly used by health plans to implement tiered network benefit designs where members pay lower cost sharing for high-rated providers. CMS publishes hospital star ratings based on Hospital Compare quality measures and Medicare Advantage plan star ratings based on HEDIS and CAHPS measures.
Healthcare data teams build provider star rating calculation pipelines that normalize quality scores across multiple measure domains, apply weighting methodologies, produce final star ratings, and integrate ratings into provider directory systems and member-facing applications to support informed provider selection decisions.
Standard Abbreviation
prvdr_star_rtg
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.
Related Content
Related Definitions
Looking for more healthcare terms?
Browse our complete library of 100,000+ standardized healthcare data terms
Browse All Terms