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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. Most claims are submitted electronically, but secondary claims are done on paper with the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna, and the tutorial guides viewers through filling out various boxes on the form. Box 1 is filled with “other” for commercial policy; Box 2 includes the patient’s name; Box 3 contains the patient’s date of birth and gender; Box 5 requires the address and phone number; and Box 6 identifies the patient relationship as self. The presenter also notes to enter guarantor information if the patient is not self-insured.
