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In today's tutorial, I will demonstrate how to complete a HICFA 1500 claim form, which non-institutional healthcare providers use to submit claims. Most of my submissions are electronic, but secondary claims require paper submissions with the primary ELB. We’ll be filling out the form for a patient named Edna. For box 1, we select "other" since it’s a commercial policy, and enter the member ID. Box 2 is for the patient’s name, while box 3 requires the patient's date of birth and gender. Box 5 includes the patient's address and phone number, and box 6 is for the patient relationship, which in this case is "self." If there were a different policyholder, we would enter their details. Finally, we’ll note the insurance plan name in box 7 and determine if there is another health benefit plan.
