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 1. Claim header table fields

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: Active Cancelled Denied Draft Entered in error In hold Paid Suspended 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: Institutional Oral Pharmacy Professional Vision For more information about the available claim types, see claim types defined in the FHIR specifications.