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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which non-institutional health care providers use to submit claims. While most claims are submitted electronically, secondary claims are submitted on paper with the primary EOB. The example provided is for a patient named Edna, with the type of insurance marked as "Other" in Box 1, indicating a commercial policy. The form is filled out with Edna's member ID, name, date of birth, gender, address, phone number, and relationship status (self). If there was another policyholder, their information would be included, but in this case, only Edna's information is necessary. The video also touches upon the other health benefit plans in the example.
