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In this video, the tutorial demonstrates how to complete a HICFA 1500 claim form, which is used by non-institutional healthcare providers to submit claims. The presenter typically submits claims electronically but discusses the process for submitting a secondary claim on paper with the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna. The tutorial advises filling in specific sections: Box 1 indicates the type of insurance (selecting "Other" for a commercial policy), Box 2 is for the patient’s name, Box 3 for the patient's date of birth and gender, Box 5 for the address and phone number, Box 6 for patient relationship (noting "self" in this case), and Box 4 (not detailed in the provided text) would contain the patient's information if they are self-insured or if another policyholder is involved.
