$50.00Deductible5/14/19px anddxcodesNONo, thiswas partof anotherprocedureElectronicclaimThis is yourcopay, youareresponsibleE0105HMOremitcodesFullydeniedECHS/IOP120daysMedicaremaximumrate$110.77HMOcomments$103.82ModifiermissingYESCMS1500AcceptedYes, sendto addresson back ofcardUB-04You onlyowe yourcost share$50.00Deductible5/14/19px anddxcodesNONo, thiswas partof anotherprocedureElectronicclaimThis is yourcopay, youareresponsibleE0105HMOremitcodesFullydeniedECHS/IOP120daysMedicaremaximumrate$110.77HMOcomments$103.82ModifiermissingYESCMS1500AcceptedYes, sendto addresson back ofcardUB-04You onlyowe yourcost share

CLAIMS BINGO! - 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. $50.00
  2. Deductible
  3. 5/14/19
  4. px and dx codes
  5. NO
  6. No, this was part of another procedure
  7. Electronic claim
  8. This is your copay, you are responsible
  9. E0105
  10. HMO remit codes
  11. Fully denied
  12. ECHS/IOP
  13. 120 days
  14. Medicare maximum rate
  15. $110.77
  16. HMO comments
  17. $103.82
  18. Modifier missing
  19. YES
  20. CMS 1500
  21. Accepted
  22. Yes, send to address on back of card
  23. UB-04
  24. You only owe your cost share