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In this video tutorial, the presenter demonstrates how to complete the HICFA 1500 claim form used by non-institutional healthcare providers. The focus is mainly on electronic submissions, but the presenter discusses the process for paper claims when submitting secondary claims alongside the primary explanation of benefits (EOB). The example used is for a patient named Edna. The presenter explains the information required in each box: Box 1 is for the type of insurance (selecting "other" for commercial), Box 2 is the patient's name, Box 3 includes the patient's date of birth and gender, Box 5 is for the patient's address and phone number, and Box 6 indicates the patient's relationship, which is "self" in this case. If there were a guarantor, their information would be included instead. The example continues with more details related to the insurance plan.
