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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, which non-institutional healthcare providers use to submit claims. Most claims are submitted electronically, but secondary claims may be submitted on paper with the primary EOB. The tutorial illustrates filling out the form for a patient named Edna. Key entries include selecting "Other" for box 1 (commercial policy), filling in the member ID in box 2, and providing the patient's name, birth date, gender, address, and phone number in boxes 3 and 5. Box 6 is completed with the patient's relationship to the insured, noted as "self" in this case. If there were a different policyholder, their information would be included instead. The presenter also prompts consideration of any other health benefit plans in box E.
