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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, commonly used by non-institutional health care providers to submit claims. The focus is on submitting a secondary claim on paper alongside the primary Explanation of Benefits (EOB). The example involves filling out the form for a patient named Edna. Key steps include selecting "other" for the insurance type in box one, entering the member ID, and providing the patient's name (box 2), date of birth and gender (box 3), address and phone number (box 5), and relationship to insurer (box 6, indicated as self). If there were a different policyholder, their information would be entered instead. The tutorial also mentions confirming if there is another health benefit plan.
