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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, which is used by non-institutional health care providers to submit claims. Most claims are submitted electronically, but a secondary claim may need to be submitted on paper with the primary Explanation of Benefits (EOB). The presenter walks through filling out the form specifically for a patient named Edna. Key points include selecting "Other" for insurance type in Box 1, entering member ID in Box 2, providing the patient's name, date of birth, and gender in Box 3, as well as the address and phone number in Box 5. Box 6 is filled with information about the patient's relationship, which is "self" in this example. The tutorial also mentions entering a guarantor's information if applicable.
