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In this video tutorial, the presenter explains how to fill out a HICFA 1500 claim form, which non-institutional health care providers use to submit claims. Most claims are submitted electronically, but secondary claims are filed on paper with the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna, with the first step being to select “Other” in box one for her commercial insurance. The tutorial covers filling in various boxes: box 2 for the patient's name, box 3 for their date of birth and gender, box 5 for the address and phone number, and box 6 for the patient's relationship to the insured. It notes that if someone other than the patient were the guarantor, their information would be entered instead. The insurance plan name is also addressed.
