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In this tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is used by non-institutional health care providers to submit claims, often electronically, but paper submissions may be required for secondary claims with primary EOBs. The example provided involves a patient named Edna, and the presenter guides viewers through the form step-by-step. Box one is completed by selecting "Other" for commercial insurance, followed by filling in the member ID. Next, box two contains the patient’s name, box three has the patient’s date of birth and gender, box five records the address and phone number, and box six indicates the patient's relationship to the insured, which is "self" in this case. Additional information for other insurance plans is also noted in box seven.
