Titration purposes,dose is notcommerciallyavailable, or dosealternatingscheduleProspectivePaymentSystembundleLidocaine/Prilocainecream, calcitriol, andlevocarnitineCarrier code:MPDOVA, Accountcode begins with an"O", Plan includes"MAO", Preferredproduct schedule isblankPerform aname search inAS400 to see ifthe memberhas a part "D"planBvsDCyclophosphamide,Anti-emetics,inhalation solutionsGoldenSixClosethe GPIYesPerform aname search inAS400 to see ifthe memberhas a part "B"planB vs DGrid5 and6BvsD fororalchemo, NF,and QLNoESRDNegativeAuthorizationExcludedfrom partB and partDTriptans,OralFentanylproducts,OpioidsKCialis 2.5mgand 5mg witha diagnosisof BPHUHCMRContinuationof therapyFertility agents,OTCs, Cosmeticagents,dietary/nutritionalsupplementsSamples weregiven or thepatient pickedup a transitionalsupplyTitration purposes,dose is notcommerciallyavailable, or dosealternatingscheduleProspectivePaymentSystembundleLidocaine/Prilocainecream, calcitriol, andlevocarnitineCarrier code:MPDOVA, Accountcode begins with an"O", Plan includes"MAO", Preferredproduct schedule isblankPerform aname search inAS400 to see ifthe memberhas a part "D"planBvsDCyclophosphamide,Anti-emetics,inhalation solutionsGoldenSixClosethe GPIYesPerform aname search inAS400 to see ifthe memberhas a part "B"planB vs DGrid5 and6BvsD fororalchemo, NF,and QLNoESRDNegativeAuthorizationExcludedfrom partB and partDTriptans,OralFentanylproducts,OpioidsKCialis 2.5mgand 5mg witha diagnosisof BPHUHCMRContinuationof therapyFertility agents,OTCs, Cosmeticagents,dietary/nutritionalsupplementsSamples weregiven or thepatient pickedup a transitionalsupply

Golden Six/QL/BvsD/MA-Only/Exclusions/ESRD - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. Titration purposes, dose is not commercially available, or dose alternating schedule
  2. Prospective Payment System bundle
  3. Lidocaine/Prilocaine cream, calcitriol, and levocarnitine
  4. Carrier code: MPDOVA, Account code begins with an "O", Plan includes "MAO", Preferred product schedule is blank
  5. Perform a name search in AS400 to see if the member has a part "D" plan
  6. BvsD
  7. Cyclophosphamide, Anti-emetics, inhalation solutions
  8. Golden Six
  9. Close the GPI
  10. Yes
  11. Perform a name search in AS400 to see if the member has a part "B" plan
  12. B vs D Grid
  13. 5 and 6
  14. BvsD for oral chemo, NF, and QL
  15. No
  16. ESRD Negative Authorization
  17. Excluded from part B and part D
  18. Triptans, Oral Fentanyl products, Opioids
  19. K
  20. Cialis 2.5mg and 5mg with a diagnosis of BPH
  21. UHCMR
  22. Continuation of therapy
  23. Fertility agents, OTCs, Cosmetic agents, dietary/nutritional supplements
  24. Samples were given or the patient picked up a transitional supply