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In this video tutorial, the presenter demonstrates how to complete the HICFA 1500 claim form, utilized by non-institutional healthcare providers for claim submissions. While most claims are electronically submitted, paper submissions are necessary for secondary claims accompanied by the primary Explanation of Benefits (EOB). The example provided is for a patient named Edna. The tutorial covers filling out various boxes: box 1 identifies the insurance type as "other" for a commercial policy, box 2 is for the patient's name, box 3 includes the patient's date of birth and gender, box 5 requires the patient's address and phone number, and box 6 details the patient’s relationship to the insured. If applicable, information for a different policyholder would be entered, but the example assumes she is self-insured. Additional information is requested about other health benefit plans.