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In this video tutorial, the author demonstrates how to complete a HICFA 1500 claim form, commonly used by non-institutional healthcare providers to submit claims. While most claims are submitted electronically, secondary claims may need to be submitted on paper alongside the primary Explanation of Benefits (EOB). The example given is for a patient named Edna, and the author details filling out various boxes: Box 1 is for insurance type, selected as "other" for a commercial policy; Box 2 is the patient's name; Box 3 includes the patient's date of birth and gender; Box 5 requires the patient's address and phone number; Box 6 indicates that the patient is self-insured. Additional information from Roxie's insurance plan name is also addressed, noting if there is another health benefit plan involved.
