Glossary
Shared language for a workflow that usually lives in tribal knowledge.
Roster operations sit between credentialing and billing, but most organizations don't have shared vocabulary for what happens in between. These definitions help.
Why it matters
These definitions help teams talk about the same problem the same way.
Terms
B
- Billing readiness
- The point at which a provider can actually submit claims to a payer and receive reimbursement.
C
- Competitive listing
- When multiple employers' roster updates conflict for the same provider in a payer directory.
- Credentialing
- The process of verifying a provider's qualifications, licenses, and background before they can participate in a payer's network.
D
- Directory accuracy
- Whether provider details in a payer's public directory match real-world provider information.
- Directory lag
- The delay between submitting a roster update to a payer and seeing that change in the payer's member-facing directory.
G
- Ghost directory
- A payer directory listing that shows incorrect, outdated, or phantom provider information.
- Ghost network
- A health plan network that appears broader or more available than it is because its provider directory contains inaccurate, outdated, or unusable listings.
N
- National Provider Identifier (NPI)
- A unique 10-digit identifier assigned to healthcare providers and healthcare organizations in the United States.
P
- Payer confirmation
- Evidence from a payer confirming a specific state of a roster update, such as delivery, acceptance, or processing.
- Post-submission visibility
- The ability to track what happens after a roster update is sent to a payer.
- Provider affiliation
- A provider's relationship to a healthcare organization, practice location, tax entity, or payer contract.
- Provider enrollment
- The process of registering a credentialed provider with a specific payer so they can submit claims and receive reimbursement.
- Provider roster
- A dataset that describes an organization's providers and their locations, specialties, identifiers, and organizational relationships.
R
- Roster reconciliation
- Comparing submitted provider data against what payer directories actually show, field by field.
- Roster submission state
- The evidence-based status of a roster update, such as delivered, accepted, processed, or reflected.
- Roster update
- A submission to a payer that adds, removes, or changes provider information tied to your organization.
- Roster validation
- Checking a payer-specific roster file for structural and record-level errors before it is submitted.
T
- Taxonomy code
- A standardized classification code for a provider's specialty used in payer directories.
- Time to bill
- The elapsed time from provider submission to a payer until they can actually bill for services.
Missing a term?
This glossary grows with the conversation.
If there's a term your team uses that isn't here, let us know. We'll add it.