Templatescompletedper PMAstandardsMonthly IWcontactdocumentedPOAaddressesmedicationmanagementDocumentemployeraccommodationstatus,Share jobdescriptionwith ALLproviders,SymptomprogressionmonitoringplandocumentedJobdescriptionshared withall providersConcentrationdifficultiesnotedUse onlyapprovedabbreviations,IW/Provider/Employercontact within 2business daysConfoundingfactorsupdatedPOAaddressespsychosocialbarriersConcisedescriptionof behavioralissue (1-2lines)Employercollaborationfor RTWdocumentedSpecialHandlingInstructionsfollowedIncludeCPT codesforprocedures,Initialadjustercontactwithin 1business dayICD-10 codeincludedwithdiagnosisLASERtechniquesdocumentedwhenappropriateRTWnegotiationbased onODGguidelinesDocumentmedicationcompliance,ActivelisteningtechniquesdocumentedAdjusterupdate within1 day ofappointmentfindingsBehavioralHealth AlertproperlydocumentedPsychosocialbarriers torecoveryidentifiedPT/OTupdatesevery 14daysOngoing IWeducationdocumentedTreatmentrequestsproperlyfacilitatedIW follow-up within2 days ofoffice visitTransitionaldutyoptionsexploredPropertemplateformatused (!bha)IncludeICD-10codes withdiagnosis,NetworkprovidersproperlydocumentedProviderfollow-upwithin 1 dayof office visitFunctionalimprovementdocumentedAlertaddressedwithin 24hoursCM AnalysisincludestreatmentplanassessmentImpact ofworry onrecoverydocumentedHealthwiseeducationdocumentedHealthwiseresourcesprovided forbehavioralhealthInitialAssessmentcompletedwithin 5business daysLASERtechniqueused withresistant IWComorbiditiesproperlydocumentedMotivationalinterviewingtechniquedocumentedODGbenchmarksreferencedSpecificactions withexact datesdocumentedTemplatescompletedper PMAstandardsMonthly IWcontactdocumentedPOAaddressesmedicationmanagementDocumentemployeraccommodationstatus,Share jobdescriptionwith ALLproviders,SymptomprogressionmonitoringplandocumentedJobdescriptionshared withall providersConcentrationdifficultiesnotedUse onlyapprovedabbreviations,IW/Provider/Employercontact within 2business daysConfoundingfactorsupdatedPOAaddressespsychosocialbarriersConcisedescriptionof behavioralissue (1-2lines)Employercollaborationfor RTWdocumentedSpecialHandlingInstructionsfollowedIncludeCPT codesforprocedures,Initialadjustercontactwithin 1business dayICD-10 codeincludedwithdiagnosisLASERtechniquesdocumentedwhenappropriateRTWnegotiationbased onODGguidelinesDocumentmedicationcompliance,ActivelisteningtechniquesdocumentedAdjusterupdate within1 day ofappointmentfindingsBehavioralHealth AlertproperlydocumentedPsychosocialbarriers torecoveryidentifiedPT/OTupdatesevery 14daysOngoing IWeducationdocumentedTreatmentrequestsproperlyfacilitatedIW follow-up within2 days ofoffice visitTransitionaldutyoptionsexploredPropertemplateformatused (!bha)IncludeICD-10codes withdiagnosis,NetworkprovidersproperlydocumentedProviderfollow-upwithin 1 dayof office visitFunctionalimprovementdocumentedAlertaddressedwithin 24hoursCM AnalysisincludestreatmentplanassessmentImpact ofworry onrecoverydocumentedHealthwiseeducationdocumentedHealthwiseresourcesprovided forbehavioralhealthInitialAssessmentcompletedwithin 5business daysLASERtechniqueused withresistant IWComorbiditiesproperlydocumentedMotivationalinterviewingtechniquedocumentedODGbenchmarksreferencedSpecificactions withexact datesdocumented

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