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