Patient'sGender_______RevenueCode________PrincipalDiagnosisCode_________Type ofBill_______Patient'sAddress_______BillingProviderName_________OccurenceCodes________AdmissionType_________MedicalRecordNumber_________HCPCS/Rates_______PatientDischargeStatus________AdmissionDate_________ConditionCodes________Patient'sDOB_______ValueCodes_______PatientControlNumber________PatientStatus_______ServiceDate_______PatientName_______AdmissionSource_________Units ofService_______AttendingPhysicianName________StatementCoversPeriod__________TotalCharges_______Patient'sGender_______RevenueCode________PrincipalDiagnosisCode_________Type ofBill_______Patient'sAddress_______BillingProviderName_________OccurenceCodes________AdmissionType_________MedicalRecordNumber_________HCPCS/Rates_______PatientDischargeStatus________AdmissionDate_________ConditionCodes________Patient'sDOB_______ValueCodes_______PatientControlNumber________PatientStatus_______ServiceDate_______PatientName_______AdmissionSource_________Units ofService_______AttendingPhysicianName________StatementCoversPeriod__________TotalCharges_______

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