E0105ModifiermissingThis is yourcopay, youareresponsibleNo, thiswas partof anotherprocedureAccepted$50.00Yes, sendto addresson back ofcardYESDeductiblepx anddxcodesHMOremitcodes120daysYou onlyowe yourcost shareElectronicclaimMedicaremaximumrateUB-04$103.82FullydeniedECHS/IOPCMS1500$110.77HMOcommentsNO5/14/19E0105ModifiermissingThis is yourcopay, youareresponsibleNo, thiswas partof anotherprocedureAccepted$50.00Yes, sendto addresson back ofcardYESDeductiblepx anddxcodesHMOremitcodes120daysYou onlyowe yourcost shareElectronicclaimMedicaremaximumrateUB-04$103.82FullydeniedECHS/IOPCMS1500$110.77HMOcommentsNO5/14/19

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