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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is utilized by non-institutional healthcare providers to submit claims. While most claims are submitted electronically, secondary claims may be submitted on paper along with the primary Explanation of Benefits (EOB). The example focuses on a claim for a patient named Edna, starting with box 1, where "Other" is selected for insurance type since it’s a commercial policy. The member ID is filled in, followed by the patient’s name in box 2, date of birth and gender in box 3, and address and phone number in box 5. The patient relationship in box 6 is listed as "self." If the patient had a different policyholder, their information would be input instead. The insurance plan name is noted as well.
