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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form used by non-institutional healthcare providers for claim submissions. Most claims are submitted electronically, but paper forms are used for secondary claims alongside the primary Explanation of Benefits. The example provided involves a patient named Edna. The tutorial covers filling out various boxes: Box 1 is for the type of insurance (selected as “Other” for a commercial policy), Box 2 is for the patient's name, Box 3 includes the patient’s date of birth and gender, Box 5 contains the address and phone number, and Box 6 indicates the patient’s relationship to the insured, which in this case is "self." If there were a different policyholder, their information would be entered instead. Box E addresses any additional health benefit plans.
