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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, used by non-institutional health care providers to submit claims. Although most claims are submitted electronically, the presenter details the process for a paper secondary claim accompanied by the primary Explanation of Benefits (ELB). The example claim is for a patient named Edna, with specific instructions to select 'other' for the type of insurance in Box 1, given it's a commercial policy. The presenter guides viewers to fill in various boxes: Box 2 for the patient’s name, Box 3 for their date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient's relationship to the insured. If there were a different policyholder, their details would be entered.
