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