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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form used by non-institutional healthcare providers to submit claims. The majority of claims are submitted electronically, but paper submissions are used for secondary claims with the primary explanation of benefits (EOB). The example given is for a patient named Edna, where box one indicates the type of insurance as "other" for a commercial policy, and the member ID is filled in. Additional details include 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. If a guarantor were involved, their information would be entered instead. Lastly, the insurance plan name is referenced in box E, followed by details about other health benefit plans.
