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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 for submitting claims. Most claims are submitted electronically, but paper submissions are necessary for secondary claims using the primary Explanation of Benefits (EOB). The example used in the video is for a patient named Edna. Key details include selecting "Other" in Box 1 for a commercial policy, entering the member ID, patient name in Box 2, and date of birth and gender in Box 3. Box 5 requires the patient's address and phone number, while Box 6 indicates the patient’s relationship as "self." If there were a different policyholder, their information would be entered. The example continues with insurance plan-related details.
