It reads every <link rel="alternate" hreflang="..."> tag in the page's <head>, resolves each destination to an absolute URL, and runs four checks: whether the page correctly references itself, whether an x-default entry exists when there are multiple real variants, whether any language code is duplicated across two different destination URLs, and whether each hreflang value looks like a valid language code.
How to fix what it finds
A missing self-reference is fixed by adding one more <link> tag to the page's own hreflang set, pointing at its own URL. Duplicate codes mean two entries are competing for the same language/region — pick the correct destination and remove the other. Malformed codes are almost always a typo, most commonly an underscore where a hyphen belongs (en_US instead of en-US). Once fixed, run the same URL back through this tool to confirm it comes back clean.