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In this video tutorial, the presenter explains how to complete a HICFA 1500 claim form, utilized by non-institutional health care providers to submit claims. Most claims are submitted electronically, but secondary claims are submitted on paper with the primary explanation of benefits (EOB). The example provided is for a patient named Edna, with insurance type selected as "other" for a commercial policy. Key sections are filled out: Box 1 for insurance type, Box 2 for patient name, Box 3 for patient date of birth and gender, Box 5 for address and phone number, and Box 6 for patient relationship, which is "self" in this case. If the patient were insured under a different policyholder, that information would be recorded instead. The video also mentions including the insurance plan name in Box E.
