CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Appendix C - PBP_2010_screenshots_sec_c_2008_12_12

CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

OMB: 0938-0763

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PBP 2010 Data Entry System Screens

SECTION C – OON – GENERAL – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – GENERAL – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – GENERAL – NOTES SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – INPATIENT – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – INPATIENT – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – INPATIENT – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – INPATIENT – BASE 4 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – SNF – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – SNF – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – GROUPS – GROUP SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – GROUPS – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – OON – GROUPS – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GENERAL – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GENERAL – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GENERAL – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GENERAL – NOTES SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – INPATIENT – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – INPATIENT – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – INPATIENT – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – INPATIENT – BASE 4 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – INPATIENT – BASE 5 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – SNF – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – SNF – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GROUPS – GROUP SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GROUPS – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – POS – GROUPS – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – GENERAL – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – GENERAL –NOTES SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – INPATIENT – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – INPATIENT – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – INPATIENT – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – INPATIENT – BASE 4 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – SNF – BASE 1 SCREEN

SECTION C – COST SHARE REDUCTION – SNF – BASE 2 SCREEN
CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – GROUPS – GROUP SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – GROUPS – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 36 of 61

PBP 2010 Data Entry System Screens

SECTION C – COST SHARE REDUCTION – GROUPS – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL –BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL –U.S. – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL –U.S. – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL –U.S. – NOTES SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – U.S. – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – U.S. – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – U.S. – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – U.S. – BASE 4 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – SNF – U.S. – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – SNF – U.S. – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 47 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – U.S. –NUMBER OF GROUPS SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 48 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – U.S. – GROUPS – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL – FOREIGN – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL – FOREIGN – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 51 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL – FOREIGN – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 52 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – GENERAL – FOREIGN – NOTES SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 53 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – FOREIGN – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 54 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – FOREIGN – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – FOREIGN – BASE 3 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 56 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – INPATIENT – FOREIGN – BASE 4 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

Page 57 of 61

PBP 2010 Data Entry System Screens

SECTION C – V/T – SNF – FOREIGN – BASE 1 SCREEN

SECTION C – V/T – SNF – FOREIGN – BASE 2 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – FOREIGN – NUMBER OF GROUPS SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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PBP 2010 Data Entry System Screens

SECTION C – V/T – GROUPS – FOREIGN – BASE 1 SCREEN

CY 2010 PBP/SB Beta PRA Package – Section C

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