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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form used by non-institutional health care providers to submit claims. The majority of claims are submitted electronically, but secondary claims may be submitted on paper along with a primary Explanation of Benefits (EOB). The tutorial focuses on filling out the form for a patient named Edna, starting with selecting "Other" for the type of insurance in Box 1. The presenter explains the information needed for each box: Box 2 requires the patient's name, Box 3 captures the patient's date of birth and gender, Box 5 is for the patient's address and phone number, and Box 6 indicates patient relationship—marked as self for this example. The form continues with Roxie insurance plan details and inquiries about other health benefit plans as applicable.
