OccurenceCodes________Patient'sDOB_______Units ofService_______AdmissionType_________ValueCodes_______RevenueCode________Type ofBill_______StatementCoversPeriod__________TotalCharges_______AttendingPhysicianName________AdmissionDate_________ServiceDate_______PatientControlNumber________PatientName_______PrincipalDiagnosisCode_________Patient'sAddress_______HCPCS/Rates_______Patient'sGender_______ConditionCodes________PatientStatus_______PatientDischargeStatus________BillingProviderName_________AdmissionSource_________MedicalRecordNumber_________OccurenceCodes________Patient'sDOB_______Units ofService_______AdmissionType_________ValueCodes_______RevenueCode________Type ofBill_______StatementCoversPeriod__________TotalCharges_______AttendingPhysicianName________AdmissionDate_________ServiceDate_______PatientControlNumber________PatientName_______PrincipalDiagnosisCode_________Patient'sAddress_______HCPCS/Rates_______Patient'sGender_______ConditionCodes________PatientStatus_______PatientDischargeStatus________BillingProviderName_________AdmissionSource_________MedicalRecordNumber_________

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