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In this video tutorial, the presenter guides viewers on completing a HICFA 1500 claim form, primarily used by non-institutional healthcare providers to submit claims. The focus is on submitting secondary claims on paper using the primary Explanation of Benefits (EOB). The example claim is for a patient named Edna, with details filled in for specific boxes: Box 1 selects "other" for the commercial policy under insurance type, Box 2 includes the patient’s name, Box 3 includes date of birth and gender, Box 5 provides the address and phone number, and Box 6 indicates the patient’s relationship as self. Additionally, the presenter notes that if another policyholder is involved, their information would be included instead. The insurance plan name is discussed in Box E, checking for any additional health benefit plans.
