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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which non-institutional healthcare providers use to submit claims. Although most claims are submitted electronically, secondary claims may be submitted on paper. The example provided involves a patient named Edna. The presenter explains the details needed for various boxes on the form: Box 1 requires selecting "Other" for commercial insurance; Box 2 is for the patient's name; Box 3 includes the patient's date of birth and gender; Box 5 captures the patient's address and phone number; Box 6 specifies the patient’s relationship to the insured, which is "self" in this case. If there were a different policyholder, their information would be entered instead. The form also includes sections for insurance plan details.
