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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, commonly used by non-institutional healthcare providers for claims submissions. The tutorial focuses on filling out the necessary sections for a secondary claim submission, which is typically done on paper with the primary Explanation of Benefits (EOB). Key details are covered, including selecting insurance type in Box 1 (e.g., 'Other' for commercial policies), entering the member ID, patient’s name (Box 2), date of birth and gender (Box 3), and contact details (Box 5). The relationship of the patient, in this case, is 'self', indicated in Box 6, with further instructions for handling different policyholders if applicable. The presenter also mentions the insurance plan name in Box 5.
