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In today's video tutorial, the focus is on completing a HICFA 1500 claim form, which is utilized by non-institutional healthcare providers for claim submissions. While most claims are submitted electronically, paper submissions are necessary for secondary claims alongside the primary Explanation of Benefits (EOB). The example provided includes patient Edna. In Box 1, "other" is selected as her insurance type, since it is a commercial policy, followed by filling in her member ID. Boxes 2 and 3 gather the patient's name, date of birth, and gender. Box 5 requires the patient's address and phone number, whereas Box 6 indicates the patient’s relationship as "self." If applicable, different guarantor information would be entered, but in this example, it remains the patient's own details. Lastly, the insurance plan name is requested in Box E, addressing potential secondary health benefit plans.
