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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 focus is on submitting a secondary claim on paper, referencing the primary Explanation of Benefits (ELB). The example involves a patient named Edna, starting with selecting "Other" for the insurance type in Box 1 since it’s a commercial policy. The tutorial includes filling out Box 2 with the patient's name, Box 3 with the date of birth and gender, Box 5 with the address and phone number, and Box 6 indicating the patient’s relationship as "self." If the insured is not the patient, information for the guarantor would be entered instead. The video continues to address additional sections of the form.
