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In today's video tutorial, the process of completing a HICFA 1500 claim form for non-institutional healthcare providers is demonstrated. The claims are primarily submitted electronically; however, secondary claims are submitted using paper forms alongside the primary Explanation of Benefits (EOB). The example covers basic entries on the form, starting with insurance type in box one, marking it as 'other' for a commercial policy, followed by filling in details like member ID, patient name in box two, patient date of birth and gender in box three, along with their address and phone number in box five. Box six captures the patient’s relationship, noted as self for this example. If applicable, different policyholder information would be included. The last point mentions verifying if there is another health benefit plan.
