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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form for non-institutional health care providers. Although most claims are submitted electronically, secondary claims may be submitted on paper along with the primary Explanation of Benefits (EOB). The tutorial demonstrates filling out various boxes: Box 1 indicates the type of insurance (selected as "other" for a commercial policy), Box 2 requires the patient's name, Box 3 needs the patient's date of birth and gender, and Box 5 is for the patient's address and phone number. Box 6 addresses the patient’s relationship to the insured (self in this case), and also notes that if the patient had a different guarantor, their information would be included instead. Additionally, Box E pertains to whether there is another health benefit plan involved.
