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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, used by non-institutional healthcare providers to submit claims. Most submissions are done electronically, but secondary claims are submitted on paper with the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna. The presenter demonstrates filling out various sections: Box 1 is for insurance type, selecting "Other" for a commercial policy; Box 2 includes the patient's name; Box 3 contains the patient's date of birth and gender; Box 5 lists the patient's address and phone number; Box 6 denotes the patient’s relationship to the insured, specified as "self." Other relevant information, such as the insurance plan name, is also included.
