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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form for non-institutional health care providers to submit claims. While most claims are submitted electronically, secondary claims are submitted on paper alongside the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna, with the insurance type coded as "Other" for a commercial policy. Key fields include the member ID, patient name, date of birth, gender, address, phone number, and relationship to the insured. The form is filled out with Edna's information, indicating "self" as her relationship to the insurance policy, and addresses the case of a guarantor when applicable. Lastly, it queries if there is another health benefit plan involved.
