(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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Employer collaboration for RTW documented
Active listening techniques documented
Treatment requests properly facilitated
ICD-10 code included with diagnosis
Specific actions with exact dates documented
4.
Proper template format used (!bha)
Specific actions with exact dates documented
Create specific Plan of Action
Proper template format used (!bha)
11.
Concentration difficulties noted
14.
Functional improvement documented
24.
Initial adjuster contact within 1 business day
Document IW education with Healthwise
Initial Assessment completed within 5 business days
3.
Healthwise resources provided for behavioral health
Alert addressed within 24 hours
Impact of worry on recovery documented
Initial Assessment completed within 5 business days
Use LASER framework with resistant IW
Ongoing IW education documented
16.
Proper template format used (!bha)
Document medication compliance,
Concentration difficulties noted
Symptom progression monitoring plan documented
IW/Provider/Employer contact within 2 business days
Motivational interviewing technique documented
9.
Alert addressed within 24 hours
6.
Symptom progression monitoring plan documented
15.
Employer collaboration for RTW documented
Share job description with ALL providers,
30.
Document medication compliance,
Monthly IW contact documented
Document RTW progress against ODG
POA addresses psychosocial barriers
Network providers properly documented
Share job description with ALL providers,
Adjuster update within 1 day of appointment findings
6.
POA addresses psychosocial barriers
Use only approved abbreviations
Special Handling Instructions followed
Employer collaboration for RTW documented
19.
Provider follow-up within 1 day of office visit
Monthly IW contact documented
Templates completed per PMA standards
Healthwise education documented
15.
Initial Assessment completed within 5 business days
Include CPT codes for procedures,
27.
Provider follow-up within 1 day of office visit
Include ICD-10 codes with diagnosis,
ODG benchmarks referenced
Provider follow-up within 1 day of office visit
5.
Document network status of providers
Concentration difficulties noted
Include CPT codes for procedures
Psychosocial barriers to recovery identified
Document employer accommodation status
PT/OT updates every 14 days
CM Analysis includes treatment plan assessment
Treatment requests properly facilitated
ICD-10 code included with diagnosis
2.
Document psychosocial barriers
Job description shared with all providers
POA addresses psychosocial barriers
11.
Network providers properly documented
Document PT updates every 14 days
Initial adjuster contact within 1 business day
1.
Concise description of behavioral issue (1-2 lines)
Include ICD-10 codes with diagnosis
Network providers properly documented
13.
Impact of worry on recovery documented
13.
Adjuster update within 1 day of appointment findings
Healthwise education documented
Document employer accommodation status,
29.
Use only approved abbreviations,
31.
IW/Provider/Employer contact within 2 business days
2.
Translate medical terms to layman's terms
IW follow-up within 2 days of office visit
IW follow-up within 2 days of office visit
IW follow-up within 2 days of office visit
4.
Templates completed per PMA standards
12.
Healthwise education documented
Active listening techniques documented
POA addresses medication management
10.
Transitional duty options explored
20.
Psychosocial barriers to recovery identified
10.
Psychosocial barriers to recovery identified
POA addresses medication management
POA addresses medication management
Comorbidities properly documented
Document employer accommodation status,
RTW negotiation based on ODG guidelines
18.
Complete Initial Assessment within 5 days
Document medication compliance,
28.
Contact adjuster within 1 business day
Confounding factors updated
5.
ODG benchmarks referenced
23.
Comorbidities properly documented
22.
Document medication compliance
LASER technique used with resistant IW
Behavioral Health Alert properly documented
Behavioral Health Alert properly documented
1.
LASER techniques documented when appropriate
25.
Healthwise resources provided for behavioral health
LASER technique used with resistant IW
Use only approved abbreviations,
Behavioral Health Alert properly documented
Include CPT codes for procedures,
Follow up on ancillary services
Include CPT codes for procedures,
CM Analysis includes treatment plan assessment
Concise description of behavioral issue (1-2 lines)
Share job description with ALL providers,
Templates completed per PMA standards
LASER techniques documented when appropriate
Motivational interviewing technique documented
Concise description of behavioral issue (1-2 lines)
3.
Document RTW barriers
Use only approved abbreviations,
Healthwise resources provided for behavioral health
8.
Alert addressed within 24 hours
Document employer accommodation status,
IW/Provider/Employer contact within 2 business days
Contact provider within 1 day of OV
Initial adjuster contact within 1 business day
Document current functionality
Adjuster update within 1 day of appointment findings
