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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form for non-institutional healthcare providers to submit their claims. While most claims are submitted electronically, secondary claims may require a paper submission with the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna. The tutorial demonstrates filling out key sections: Box 1 identifies the type of insurance as "other" for a commercial policy, Box 2 includes the patient's name, Box 3 captures the patient's date of birth and gender, Box 5 provides the address and phone number, and Box 6 notes the patient's relationship to the insured, which in this case is "self." If the patient weren't self-insured, guarantor information would be entered. The insurance plan name is also specified in the process.
