Claim header table
The Claim header [sn_hcls_claim_header] table stores the details of the main claim submitted on behalf of a patient to a payer organization.
The table has the following features:
- Stores the main claim submitted on behalf of a patient to a payer organization.
- Enables including multiple claim lines.
- Includes the payer, transaction control number, type, status, patient, member plan, medical record number, account number, and various dates and amounts.
Role required to configure the table: sn_hcls.admin.
For more information, see Healthcare and Life Sciences data model.
|
Field |
Data type |
Description |
|---|---|---|
|
Adjudicated amount |
Currency |
Adjusted amount paid for the service by the primary payer. |
|
Billed DRG code |
String |
Diagnosis Related Group (DRG) code for the billed diagnosis-related group. |
|
Claim amount |
Currency |
Original amount submitted with the claim. |
|
Date accepted |
Date |
Date when the claim was accepted by the payer organization. |
|
Date adjudicated |
Date |
Date when the claim was adjudicated for the payment. |
|
Date paid |
Date |
Date when the claim was paid by the payer organization. |
|
Date submitted |
Date |
Date when the claim was submitted to the payer organization. |
|
Fee reduction amount |
Currency |
Difference between the original claim amount and the adjusted paid amount. |
|
Medical record number |
String |
Medical Record Number (MRN) of the patient as entered in the electronic medical records (EMR) system. |
|
Member plan |
Reference |
Member plan associated with the patient. |
|
Name |
String |
Name to identify the claim header. |
|
Number |
String |
Alpha-numeric profile identifier of the claim header. The value is auto-generated and is incremented every time you add a new claim header to an instance. The initial value for the Number field is CLAIMHDR00001001. Note: To customize the number, define the auto-numbering format for the Claim header [sn_hcls_claim_header] table. For more information, see Add auto-numbering records in a table. |
|
Paid amount |
Currency |
Amount to be paid by the patient. |
|
Patient |
Reference |
Patient on whose behalf the claim was submitted. |
|
Patient account number |
String |
Patient account number as entered in the EMR system. |
|
Patient payable amount |
Currency |
Amount for which the patient is responsible. |
|
Payer |
Reference |
Name of the company listed as a payer organization. |
|
Preauthorization header |
Reference |
Associated pre-authorization request. |
|
Remarks |
String |
Comments or additional information about the claim. |
|
Service provider |
Reference |
Practitioner who provided the service to the patient. |
|
Service provider id |
String |
Identifier of the practitioner who provided the product or service to the patient. |
|
Source |
Reference |
Source system details of an external healthcare system in a ServiceNow instance. |
|
Status |
Choice list |
Status of the claim. The following statuses are available by default:
For more information about the available statuses, see claim statuses defined in the FHIR specifications. |
|
Transaction control number |
String |
Unique identifier of the claim in the payer system. |
|
Type |
Choice list |
Type of the claim. The following types are available by default:
For more information about the available claim types, see claim types defined in the FHIR specifications. |
--- title: Claim header table description: The Claim header \[sn\_hcls\_claim\_header\] table stores the details of the main claim submitted on behalf of a patient to a payer organization. locale: en-US canonical_url: https://www.servicenow.com/docs/r/australia/healthcare-life-sciences/healthcare-and-life-sciences-service-management-core/hcls-claim-header-table.html release: australia product: Healthcare and Life Sciences Service Management Core classification: healthcare-and-life-sciences-service-management-core topic_type: reference last_updated: "2026-09-10" reading_time_minutes: 2 breadcrumb: [Data model tables, Reference, Healthcare and Life Sciences Service Management Core, Healthcare and Life Sciences Service Management, Healthcare and Life Sciences] --- # Claim header table The Claim header \[sn\_hcls\_claim\_header\] table stores the details of the main claim submitted on behalf of a patient to a payer organization. The table has the following features: - Stores the main claim submitted on behalf of a patient to a payer organization. - Enables including multiple claim lines. - Includes the payer, transaction control number, type, status, patient, member plan, medical record number, account number, and various dates and amounts. Role required to configure the table: sn\_hcls.admin. For more information, see [Healthcare and Life Sciences data model](). <table id="table_i41_xh3_npb"><thead><tr><th> Field </th><th> Data type </th><th> Description </th></tr></thead><tbody><tr><td> Adjudicated amount </td><td> Currency </td><td> Adjusted amount paid for the service by the primary payer. </td></tr><tr><td> Billed DRG code </td><td> String </td><td> Diagnosis Related Group \(DRG\) code for the billed diagnosis-related group. </td></tr><tr><td> Claim amount </td><td> Currency </td><td> Original amount submitted with the claim. </td></tr><tr><td> Date accepted </td><td> Date </td><td> Date when the claim was accepted by the payer organization. </td></tr><tr><td> Date adjudicated </td><td> Date </td><td> Date when the claim was adjudicated for the payment. </td></tr><tr><td> Date paid </td><td> Date </td><td> Date when the claim was paid by the payer organization. </td></tr><tr><td> Date submitted </td><td> Date </td><td> Date when the claim was submitted to the payer organization. </td></tr><tr><td> Fee reduction amount </td><td> Currency </td><td> Difference between the original claim amount and the adjusted paid amount. </td></tr><tr><td> Medical record number </td><td> String </td><td> Medical Record Number \(MRN\) of the patient as entered in the electronic medical records \(EMR\) system. </td></tr><tr><td> Member plan </td><td> Reference </td><td> Member plan associated with the patient. </td></tr><tr><td> Name </td><td> String </td><td> Name to identify the claim header. </td></tr><tr><td> Number </td><td> String </td><td> Alpha-numeric profile identifier of the claim header. The value is auto-generated and is incremented every time you add a new claim header to an instance. The initial value for the **Number** field is CLAIMHDR00001001. **Note:** To customize the number, define the auto-numbering format for the Claim header \[sn\_hcls\_claim\_header\] table. For more information, see Add auto-numbering records in a table. </td></tr><tr><td> Paid amount </td><td> Currency </td><td> Amount to be paid by the patient. </td></tr><tr><td> Patient </td><td> Reference </td><td> Patient on whose behalf the claim was submitted. </td></tr><tr><td> Patient account number </td><td> String </td><td> Patient account number as entered in the EMR system. </td></tr><tr><td> Patient payable amount </td><td> Currency </td><td> Amount for which the patient is responsible. </td></tr><tr><td> Payer </td><td> Reference </td><td> Name of the company listed as a payer organization. </td></tr><tr><td> Preauthorization header </td><td> Reference </td><td> Associated pre-authorization request. </td></tr><tr><td> Remarks </td><td> String </td><td> Comments or additional information about the claim. </td></tr><tr><td> Service provider </td><td> Reference </td><td> Practitioner who provided the service to the patient. </td></tr><tr><td> Service provider id </td><td> String </td><td> Identifier of the practitioner who provided the product or service to the patient. </td></tr><tr><td> Source </td><td> Reference </td><td> Source system details of an external healthcare system in a ServiceNow instance. </td></tr><tr><td> Status </td><td> Choice list </td><td> Status of the claim. The following statuses are available by default: - Active - Cancelled - Denied - Draft - Entered in error - In hold - Paid - Suspended For more information about the available statuses, see [claim statuses](http://hl7.org/fhir/2016sep/codesystem-claim-status.html) defined in the FHIR specifications. </td></tr><tr><td> Transaction control number </td><td> String </td><td> Unique identifier of the claim in the payer system. </td></tr><tr><td> Type </td><td> Choice list </td><td> Type of the claim. The following types are available by default: - Institutional - Oral - Pharmacy - Professional - Vision For more information about the available claim types, see [claim types](https://www.hl7.org/fhir/valueset-claim-type.html) defined in the FHIR specifications. </td></tr></tbody> </table>**Parent Topic:**[Healthcare and Life Sciences data model tables](https://raw.githubusercontent.com/ServiceNow/ServiceNowDocs/australia/markdown/australia/healthcare-life-sciences/healthcare-and-life-sciences-service-management-core/hcls-healthcare-data-tables.md)
| title | Claim header table |
| description | The Claim header \[sn\_hcls\_claim\_header\] table stores the details of the main claim submitted on behalf of a patient to a payer organization. |
| locale | en-US |
| canonical_url | https://www.servicenow.com/docs/r/australia/healthcare-life-sciences/healthcare-and-life-sciences-service-management-core/hcls-claim-header-table.html |
| release | australia |
| product | Healthcare and Life Sciences Service Management Core |
| classification | healthcare-and-life-sciences-service-management-core |
| topic_type | reference |
| last_updated | 2026-09-10 |
| reading_time_minutes | 2 |
| breadcrumb | Data model tablesReferenceHealthcare and Life Sciences Service Management CoreHealthcare and Life Sciences Service ManagementHealthcare and Life Sciences |