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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. While most claims are submitted electronically, secondary claims are submitted on paper with the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna, with the insurance type selected as "other" in box 1, indicating a commercial policy. The form is filled out with details such as the member ID, patient name (box 2), date of birth and gender (box 3), address and phone number (box 5), and the patient relationship (box 6), which is "self" in this case. Additional information for other policyholders is discussed if applicable.
