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Eligibility

The eligibility table includes information about a patient's health insurance coverage and demographics (note: we use the word patient as a synonym for member). Every claims dataset should include some sort of eligibility data, otherwise it's impossible to calculate member months, which are needed to calculate measures like PMPM.

Primary Keys:

  • patient_id
  • member_id
  • enrollment_start_date
  • enrollment_end_date
ColumnData TypeDescriptionTerminology