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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, utilized by non-institutional health care providers for submitting claims. Most claims are submitted electronically, but secondary claims may require paper submission alongside the primary Explanation of Benefits (EOB). The tutorial specifically walks through filling out the form for a patient named Edna. Key sections include selecting the type of insurance (box 1), entering the member ID, and filling out the patient's name, date of birth, and gender in boxes 2 and 3. Box 5 requires the patient's address and phone number, while box 6 specifies the patient's relationship, noted as ‘self’ in this case. If a different policyholder was involved, their information would be entered instead. Further details include verifying if there is another health benefit plan.
