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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, typically used by non-institutional healthcare providers to submit claims. The focus is on submitting a secondary paper claim when primary electronic billing is not applicable. The example provided involves a patient named Edna, with details filled in for various boxes: Box 1 for insurance type (marked as "other" for a commercial policy), Box 2 for the patient’s name, Box 3 for the patient’s date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient’s relationship (noted as "self"). The tutorial emphasizes that if the patient has a different policyholder, their information would be entered instead, but in this case, it’s self-insured. Additionally, Box 11 inquires about other health benefit plans.
