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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, commonly used by non-institutional health care providers to submit claims. The presenter primarily submits claims electronically but will use a paper format for secondary claims alongside the primary Explanation of Benefits (EOB). The example provided involves a patient named Edna. Key details include selecting "Other" for insurance type in Box 1, entering the member ID, patient name (Box 2), date of birth and gender (Box 3), address and phone number (Box 5), and relationship to the insured (Box 6). The example assumes Edna is self-insured, and if a different policyholder were involved, their information would be entered accordingly. Box E addresses whether there is another health benefit plan.
