Propertemplateformatused (!bha)IncludeCPT codesforprocedures,IW follow-up within2 days ofoffice visitTemplatescompletedper PMAstandardsProviderfollow-upwithin 1 dayof office visitJobdescriptionshared withall providersHealthwiseresourcesprovided forbehavioralhealthICD-10 codeincludedwithdiagnosisRTWnegotiationbased onODGguidelinesConcentrationdifficultiesnotedLASERtechniquesdocumentedwhenappropriateOngoing IWeducationdocumentedMonthly IWcontactdocumentedInitialAssessmentcompletedwithin 5business daysEmployercollaborationfor RTWdocumentedPsychosocialbarriers torecoveryidentifiedMotivationalinterviewingtechniquedocumentedCM AnalysisincludestreatmentplanassessmentDocumentemployeraccommodationstatus,IW/Provider/Employercontact within 2business daysInitialadjustercontactwithin 1business dayLASERtechniqueused withresistant IWSymptomprogressionmonitoringplandocumentedFunctionalimprovementdocumentedPOAaddressesmedicationmanagementShare jobdescriptionwith ALLproviders,TransitionaldutyoptionsexploredImpact ofworry onrecoverydocumentedComorbiditiesproperlydocumentedODGbenchmarksreferencedBehavioralHealth AlertproperlydocumentedAdjusterupdate within1 day ofappointmentfindingsSpecificactions withexact datesdocumentedDocumentmedicationcompliance,TreatmentrequestsproperlyfacilitatedAlertaddressedwithin 24hoursPOAaddressespsychosocialbarriersIncludeICD-10codes withdiagnosis,HealthwiseeducationdocumentedSpecialHandlingInstructionsfollowedNetworkprovidersproperlydocumentedConcisedescriptionof behavioralissue (1-2lines)Use onlyapprovedabbreviations,ActivelisteningtechniquesdocumentedConfoundingfactorsupdatedPT/OTupdatesevery 14daysPropertemplateformatused (!bha)IncludeCPT codesforprocedures,IW follow-up within2 days ofoffice visitTemplatescompletedper PMAstandardsProviderfollow-upwithin 1 dayof office visitJobdescriptionshared withall providersHealthwiseresourcesprovided forbehavioralhealthICD-10 codeincludedwithdiagnosisRTWnegotiationbased onODGguidelinesConcentrationdifficultiesnotedLASERtechniquesdocumentedwhenappropriateOngoing IWeducationdocumentedMonthly IWcontactdocumentedInitialAssessmentcompletedwithin 5business daysEmployercollaborationfor RTWdocumentedPsychosocialbarriers torecoveryidentifiedMotivationalinterviewingtechniquedocumentedCM AnalysisincludestreatmentplanassessmentDocumentemployeraccommodationstatus,IW/Provider/Employercontact within 2business daysInitialadjustercontactwithin 1business dayLASERtechniqueused withresistant IWSymptomprogressionmonitoringplandocumentedFunctionalimprovementdocumentedPOAaddressesmedicationmanagementShare jobdescriptionwith ALLproviders,TransitionaldutyoptionsexploredImpact ofworry onrecoverydocumentedComorbiditiesproperlydocumentedODGbenchmarksreferencedBehavioralHealth AlertproperlydocumentedAdjusterupdate within1 day ofappointmentfindingsSpecificactions withexact datesdocumentedDocumentmedicationcompliance,TreatmentrequestsproperlyfacilitatedAlertaddressedwithin 24hoursPOAaddressespsychosocialbarriersIncludeICD-10codes withdiagnosis,HealthwiseeducationdocumentedSpecialHandlingInstructionsfollowedNetworkprovidersproperlydocumentedConcisedescriptionof behavioralissue (1-2lines)Use onlyapprovedabbreviations,ActivelisteningtechniquesdocumentedConfoundingfactorsupdatedPT/OTupdatesevery 14days

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