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In this video tutorial, the presenter demonstrates how to complete the HICFA 1500 claim form, used by non-institutional health care providers to submit claims. Although most claims are submitted electronically, secondary claims may require paper submission with the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna with a commercial insurance policy. Key points include filling in the patient’s member ID in Box 1, name in Box 2, date of birth and gender in Box 3, address and phone number in Box 5, and relationship to the insured in Box 6. If the patient is self-insured, her details are entered; otherwise, information for a guarantor would be included. The tutorial also addresses information for other health benefit plans as needed.
