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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which non-institutional health care providers use to submit claims, primarily on paper for secondary claims accompanied by a primary Explanation of Benefits (EOB). The process begins with selecting the type of insurance in Box 1, identifying it as commercial. The tutorial covers filling out the form with Edna's information, including her member ID in Box 2, patient name in Box 3, date of birth, gender, address and phone number in Box 5, and the relationship to the insured in Box 6. If the patient was not self-insured, guarantor information would be provided, but here it remains self-insured. The insurance plan name is noted in Box 8, and the form also asks if another health benefit plan exists.
