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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is used by non-institutional healthcare providers to submit claims. The tutorial centers on a claim for a patient named Edna, discussing the submission process for both electronic and paper claims. Key points include selecting "Other" for box one (insurance type), filling in member ID in box two, and providing the patient's name, date of birth, gender, address, phone number, and relationship to the insured in the subsequent boxes. The example illustrates completing the form for a self-insured patient, with details of entering information for the policyholder should there be a guarantor. The final box covers the health benefit plan information.
