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In this video tutorial, the instructor demonstrates how to complete a HICFA 1500 claim form, specifically for non-institutional health care providers. The majority of claims are submitted electronically, but secondary claims are filed on paper alongside the primary Explanation of Benefits (EOB). The tutorial outlines filling out the form, starting with the insurance type in box one ("other" for a commercial policy) and member ID. Box two requires the patient's name, and box three captures the patient's date of birth and gender. Box five is for the patient's address and phone number, while box six indicates the patient’s relationship to the insured—as "self" in this example. The tutorial also notes how to input information if the insured is not the patient.
