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In today's video, the tutorial demonstrates how to complete a HICFA 1500 claim form, which is utilized by non-institutional health care providers to submit claims. The majority of claims are submitted electronically; however, secondary claims are submitted on paper with the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna, covering key fields such as: box 1 for insurance type (selected as other for commercial policy), box 2 for the patient's name, box 3 for the date of birth and gender, box 5 for the address and phone number, and box 6 for the patient’s relationship (self in this case). If a guarantor were involved, their information would be entered instead. Additional details include the insurance plan name and inquiries about other health benefit plans.
