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In this video tutorial, the instructor demonstrates how to complete a HICFA 1500 claim form, which is utilized by non-institutional health care providers for claim submissions. While most claims are submitted electronically, secondary claims may require paper submission with the primary explanation of benefits (EOB). The example provided is for a patient named Edna, using a commercial insurance policy. Key boxes to fill include Box 1 for insurance type (selected as 'other'), Box 2 for the patient's name, Box 3 for the date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient's relationship (noting 'self' in this case). If applicable, information for a guarantor would be entered instead. Additionally, Box E is to indicate if there is another health benefit plan.
