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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is used by non-institutional health care providers for claim submissions. The majority of claims are submitted electronically, but secondary claims may be submitted on paper alongside the primary Explanation of Benefits (EOB). The tutorial specifies entering information for a patient named Edna, selecting "other" for box one to denote a commercial policy, and filling in her member ID. Subsequent boxes require the patient's name (box 2), date of birth and gender (box 3), address and phone number (box 5), and relationship to the insured (box 6, noted as self in this example). Information for any alternate policyholders would be included if applicable.
