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In this tutorial, the presenter demonstrates how to complete a HICFA 1500 claim form, which is used by non-institutional healthcare providers to submit claims. While most claims are submitted electronically, secondary claims are submitted on paper with the primary Explanation of Benefits (EOB). The example features a patient named Edna, and the tutorial outlines filling in specific boxes on the form: Box 1 indicates the insurance type as "Other" for a commercial policy, Box 2 is for the patient’s name, Box 3 for the patient’s date of birth and gender, Box 5 for the address and phone number, and Box 6 for the patient’s relationship (self in this case). If there was a different policyholder, their information would be entered instead. The tutorial also mentions entering the insurance plan name in Box E.
