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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, used by non-institutional health care providers to submit claims. The process primarily involves electronic submissions, but paper submissions are required for secondary claims with the primary Explanation of Benefits (ELB). The tutorial focuses on filling out specific sections: Box 1, where the type of insurance is entered 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 to the insured. In this example, the patient is self-insured. The presenter also mentions including information for any guarantor if applicable.
