RevenueCode________PatientDischargeStatus________AdmissionType_________Units ofService_______ConditionCodes________PrincipalDiagnosisCode_________Type ofBill_______AttendingPhysicianName________AdmissionDate_________Patient'sGender_______PatientControlNumber________PatientStatus_______ServiceDate_______AdmissionSource_________Patient'sDOB_______OccurenceCodes________MedicalRecordNumber_________HCPCS/Rates_______Patient'sAddress_______PatientName_______TotalCharges_______StatementCoversPeriod__________BillingProviderName_________ValueCodes_______RevenueCode________PatientDischargeStatus________AdmissionType_________Units ofService_______ConditionCodes________PrincipalDiagnosisCode_________Type ofBill_______AttendingPhysicianName________AdmissionDate_________Patient'sGender_______PatientControlNumber________PatientStatus_______ServiceDate_______AdmissionSource_________Patient'sDOB_______OccurenceCodes________MedicalRecordNumber_________HCPCS/Rates_______Patient'sAddress_______PatientName_______TotalCharges_______StatementCoversPeriod__________BillingProviderName_________ValueCodes_______

UB-04 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. Revenue Code ________
  2. Patient Discharge Status ________
  3. Admission Type _________
  4. Units of Service _______
  5. Condition Codes ________
  6. Principal Diagnosis Code _________
  7. Type of Bill _______
  8. Attending Physician Name ________
  9. Admission Date _________
  10. Patient's Gender _______
  11. Patient Control Number ________
  12. Patient Status _______
  13. Service Date _______
  14. Admission Source _________
  15. Patient's DOB _______
  16. Occurence Codes ________
  17. Medical Record Number _________
  18. HCPCS/ Rates _______
  19. Patient's Address _______
  20. Patient Name _______
  21. Total Charges _______
  22. Statement Covers Period __________
  23. Billing Provider Name _________
  24. Value Codes _______