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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form for non-institutional health care providers. The majority of claims are submitted electronically, but secondary claims may be filed on paper with the primary Explanation of Benefits (EOB). The example used is for a patient named Edna, starting with box 1, where "other" is selected for the type of insurance as it is a commercial policy. The presenter fills in the member ID and enters the patient's name, date of birth, gender, and contact details in boxes 2, 3, and 5. For box 6, the patient's relationship is noted as "self." If there were a different policyholder, that information would be entered, but in this case, Edna is both the patient and the insured. Additional details regarding other health benefit plans are briefly mentioned.
