PatientControlNumber________Units ofService_______HCPCS/Rates_______Type ofBill_______AdmissionType_________ValueCodes_______StatementCoversPeriod__________TotalCharges_______AdmissionSource_________Patient'sGender_______PatientName_______Patient'sAddress_______ConditionCodes________AttendingPhysicianName________PatientDischargeStatus________MedicalRecordNumber_________ServiceDate_______AdmissionDate_________RevenueCode________BillingProviderName_________OccurenceCodes________Patient'sDOB_______PrincipalDiagnosisCode_________PatientStatus_______PatientControlNumber________Units ofService_______HCPCS/Rates_______Type ofBill_______AdmissionType_________ValueCodes_______StatementCoversPeriod__________TotalCharges_______AdmissionSource_________Patient'sGender_______PatientName_______Patient'sAddress_______ConditionCodes________AttendingPhysicianName________PatientDischargeStatus________MedicalRecordNumber_________ServiceDate_______AdmissionDate_________RevenueCode________BillingProviderName_________OccurenceCodes________Patient'sDOB_______PrincipalDiagnosisCode_________PatientStatus_______

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.


1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
  1. Patient Control Number ________
  2. Units of Service _______
  3. HCPCS/ Rates _______
  4. Type of Bill _______
  5. Admission Type _________
  6. Value Codes _______
  7. Statement Covers Period __________
  8. Total Charges _______
  9. Admission Source _________
  10. Patient's Gender _______
  11. Patient Name _______
  12. Patient's Address _______
  13. Condition Codes ________
  14. Attending Physician Name ________
  15. Patient Discharge Status ________
  16. Medical Record Number _________
  17. Service Date _______
  18. Admission Date _________
  19. Revenue Code ________
  20. Billing Provider Name _________
  21. Occurence Codes ________
  22. Patient's DOB _______
  23. Principal Diagnosis Code _________
  24. Patient Status _______