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In this video tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, used by non-institutional health care providers to submit claims. Most claims are submitted electronically, but secondary claims are submitted on paper alongside the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna, with insurance categorized in Box 1 as "other" due to it being a commercial policy. The video guides viewers through filling in various fields: Box 2 for the patient's name, Box 3 for the date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient relationship, which is “self” in this case. If a different policyholder were involved, their information would be entered instead.
