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