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in todays video I want to show you how to complete a hicfa 1500 claim form this form is used by any non institutional health care provider to submit their claims the majority of the claims I submit are electronically but if I have to submit a secondary claim it will be on paper with the primary ELB so lets get started this claim is going to edna the type of insurance is for box one so were going to select other since its a commercial policy and then well fill in the member ID insured by d box 2 is the patient name and box 3 is patient date of birth and gender box 5 is the address and phone number box 6 patient relationship - in short in this example is self so one box for were going to fill in her information again if the patient was not self insured if there was a guarantor of a different policyholder we would enter their information here but again this example is self so were putting in her information Roxie insurance plan name e is there another health benefit plan in this ex