CMS-R-262 Section B-9A-Outpatient Hospital-Base 1 Scre
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
Appendix C - PBP_2008_screenshots_sec_b9
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
OMB: 0938-0763
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:
Document [doc]
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PBP 2008 Data Entry System Screens
Section B – 9a – Outpatient Hospital – Base 1 Screen
Section B – 9a – Outpatient Hospital – Base 2 Screen
Section B – 9a – Outpatient Hospital – Base 3 Screen
Section B – 9b – Ambulatory Surgical Center Services – Base 1 Screen
Section B – 9b – Ambulatory Surgical Center Services – Base 2 Screen
Section B – 9b – Ambulatory Surgical Center Services – Base 3 Screen
Section B – 9c – Outpatient Substance Abuse Services – Base 1 Screen
Section B – 9c – Outpatient Substance Abuse Services – Base 2 Screen
Section B – 9c – Outpatient Substance Abuse Services – Base 3 Screen
Section B – 9c – Outpatient Substance Abuse Services – Base 4 Screen
Section B – 9c – Outpatient Substance Abuse Services – Base 5 Screen
Section B – 9d – Cardiac Rehab Services – Base 1 Screen
Section B – 9d – Cardiac Rehab Services – Base 2 Screen
Section B – 9d – Cardiac Rehab Services – Base 3 Screen
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| File Type | application/msword |
| File Modified | 2006-12-20 |
| File Created | 2006-12-20 |
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