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In this tutorial, the presenter explains how to complete a HICFA 1500 claim form, which is used by non-institutional health care providers to submit claims. The majority of claims are submitted electronically, but secondary claims are submitted on paper alongside the primary Explanation of Benefits (EOB). The example used in the video involves a patient named Edna. The tutorial walks through filling out the form, starting with selecting "other" for the insurance type in Box 1, and entering the member ID. Subsequent boxes include the patient’s name (Box 2), date of birth and gender (Box 3), address and phone number (Box 5), and relationship to the insured (Box 6). The example assumes the patient is insured by themselves, and any guarantor or different policyholder information is noted for cases where applicable.
