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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form used by non-institutional healthcare providers to submit claims. The majority of claims are submitted electronically, but secondary claims are submitted on paper with the primary Explanation of Benefits (EOB). The example provided illustrates filling out the form for a patient named Edna. Key details covered include selecting "other" for insurance type in Box 1, entering the member ID, the patient's name (Box 2), date of birth, and gender (Box 3), as well as filling in the address and phone number (Box 5) and patient relationship (Box 6). If not self-insured, details of the guarantor would be added, but in this case, the information pertains to the patient herself. The tutorial continues with further instructions regarding additional health benefit plans.
