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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is utilized by non-institutional healthcare providers for submitting claims. The majority of claims are submitted electronically, but paper submissions may be necessary for secondary claims alongside the primary Explanation of Benefits (EOB). The example used features a patient named Edna, with insurance details recorded in specific boxes: Box 1 indicates the insurance type as "Other" for a commercial policy, while Box 2 captures the patient's name, and Box 3 includes the date of birth and gender. Box 5 is filled with the patient’s address and phone number, and Box 6 specifies the patient’s relationship, marked as "Self" in this case. Additional information, such as the insurance plan name and any other health benefit plans, is also covered.
