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In this tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, used by non-institutional healthcare providers to submit claims. The focus is on submitting secondary claims on paper alongside the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna. The video guides viewers through filling out the form, starting with selecting "other" for the insurance type in box 1, then entering the member ID, the patient's name in box 2, and date of birth and gender in box 3. Box 5 requires the patient’s address and phone number, while box 6 indicates the patient’s relationship to the insured. The example illustrates how to input information when the patient is self-insured and notes the process for entering details if there’s a different policyholder.
