Propertemplateformatused (!bha)LASERtechniqueused withresistant IWBehavioralHealth AlertproperlydocumentedConcentrationdifficultiesnotedSymptomprogressionmonitoringplandocumentedCM AnalysisincludestreatmentplanassessmentTreatmentrequestsproperlyfacilitatedConcisedescriptionof behavioralissue (1-2lines)IncludeCPT codesforprocedures,Specificactions withexact datesdocumentedTemplatescompletedper PMAstandardsIW follow-up within2 days ofoffice visitInitialadjustercontactwithin 1business dayAlertaddressedwithin 24hoursPsychosocialbarriers torecoveryidentifiedDocumentmedicationcompliance,Healthwiseresourcesprovided forbehavioralhealthAdjusterupdate within1 day ofappointmentfindingsTransitionaldutyoptionsexploredOngoing IWeducationdocumentedICD-10 codeincludedwithdiagnosisODGbenchmarksreferencedIncludeICD-10codes withdiagnosis,IW/Provider/Employercontact within 2business daysActivelisteningtechniquesdocumentedInitialAssessmentcompletedwithin 5business daysFunctionalimprovementdocumentedPT/OTupdatesevery 14daysEmployercollaborationfor RTWdocumentedMonthly IWcontactdocumentedShare jobdescriptionwith ALLproviders,Use onlyapprovedabbreviations,Jobdescriptionshared withall providersMotivationalinterviewingtechniquedocumentedComorbiditiesproperlydocumentedPOAaddressesmedicationmanagementConfoundingfactorsupdatedDocumentemployeraccommodationstatus,LASERtechniquesdocumentedwhenappropriateImpact ofworry onrecoverydocumentedRTWnegotiationbased onODGguidelinesNetworkprovidersproperlydocumentedProviderfollow-upwithin 1 dayof office visitPOAaddressespsychosocialbarriersHealthwiseeducationdocumentedSpecialHandlingInstructionsfollowedPropertemplateformatused (!bha)LASERtechniqueused withresistant IWBehavioralHealth AlertproperlydocumentedConcentrationdifficultiesnotedSymptomprogressionmonitoringplandocumentedCM AnalysisincludestreatmentplanassessmentTreatmentrequestsproperlyfacilitatedConcisedescriptionof behavioralissue (1-2lines)IncludeCPT codesforprocedures,Specificactions withexact datesdocumentedTemplatescompletedper PMAstandardsIW follow-up within2 days ofoffice visitInitialadjustercontactwithin 1business dayAlertaddressedwithin 24hoursPsychosocialbarriers torecoveryidentifiedDocumentmedicationcompliance,Healthwiseresourcesprovided forbehavioralhealthAdjusterupdate within1 day ofappointmentfindingsTransitionaldutyoptionsexploredOngoing IWeducationdocumentedICD-10 codeincludedwithdiagnosisODGbenchmarksreferencedIncludeICD-10codes withdiagnosis,IW/Provider/Employercontact within 2business daysActivelisteningtechniquesdocumentedInitialAssessmentcompletedwithin 5business daysFunctionalimprovementdocumentedPT/OTupdatesevery 14daysEmployercollaborationfor RTWdocumentedMonthly IWcontactdocumentedShare jobdescriptionwith ALLproviders,Use onlyapprovedabbreviations,Jobdescriptionshared withall providersMotivationalinterviewingtechniquedocumentedComorbiditiesproperlydocumentedPOAaddressesmedicationmanagementConfoundingfactorsupdatedDocumentemployeraccommodationstatus,LASERtechniquesdocumentedwhenappropriateImpact ofworry onrecoverydocumentedRTWnegotiationbased onODGguidelinesNetworkprovidersproperlydocumentedProviderfollow-upwithin 1 dayof office visitPOAaddressespsychosocialbarriersHealthwiseeducationdocumentedSpecialHandlingInstructionsfollowed

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