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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, used by non-institutional health care providers for submitting claims. The majority of claims are submitted electronically, but secondary claims may require a paper submission with the primary Explanation of Benefits (EOB). The example claims form is for a patient named Edna. Key steps include selecting "Other" for the type of insurance in box 1, filling out the member ID in box 2, providing the patient's name and date of birth in box 3, and entering the address and phone number in box 5. Box 6 indicates the patient relationship, which is "self" in this case. The tutorial also notes the procedure for entering information if there is a guarantor or other policyholder involved.
