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In this video tutorial, the presenter demonstrates how to fill out a HICFA 1500 claim form, primarily used by non-institutional healthcare providers for submitting claims. While most claims are submitted electronically, secondary claims are often filed on paper alongside the primary explanation of benefits (EOB). The example claim is for a patient named Edna, and the tutorial guides viewers through each relevant box: Box 1 for insurance type (selecting "other" for a commercial policy), Box 2 for the patient's name, Box 3 for the patient's date of birth and gender, Box 5 for the patient's address and phone number, Box 6 for the patient’s relationship (noting "self"), and Box 4 for the insured's information, indicating that there is no other policyholder in this example.
