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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, used by non-institutional health care providers to submit claims. The majority of claims are submitted electronically, but secondary claims are filed on paper with the primary Explanation of Benefits (EOB). The example focuses on a claim for a patient named Edna. In Box 1, the insurance type is selected as "Other" for a commercial policy. The presentation covers filling out patient details, including name (Box 2), date of birth and gender (Box 3), address and phone number (Box 5), and relationship to the insured (Box 6) as "self." If there were a different policyholder, their information would be entered instead.
