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In this video, the tutorial demonstrates how to complete a HICFA 1500 claim form, which is used by non-institutional health care providers to submit claims. The presenter typically submits most claims electronically but addresses how to submit secondary claims on paper using the primary Explanation of Benefits (ELB). The example claims are made for a patient named Edna, starting with selecting 'other' for insurance type in Box 1, followed by entering her member ID. Boxes 2 and 3 require the patient's name and date of birth with gender. Box 5 asks for the address and phone number, and Box 6 captures the patient's relationship, listed as 'self' in this case. If there was a different policyholder, their information would be entered instead. Lastly, the tutorial mentions the necessity of noting any other health benefit plans in Box E.
