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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, used by non-institutional healthcare providers for claim submissions. Although most claims are submitted electronically, secondary claims are sent on paper using the primary Explanation of Benefits (EOB). The example used involves a patient named Edna. Box 1 identifies the insurance type as "Other" since it is a commercial policy, and the member ID is filled in next. Box 2 contains the patient's name, while Box 3 captures the date of birth and gender. Box 5 includes the patient's address and phone number, and Box 6 indicates the patient relationship, noted as self in this case. If there were a different policyholder, their information would be entered instead. The tutorial briefly mentions filling in the insurance plan name in Box E and addresses any additional health benefit plans.
