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pdfPBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (COMBINED) – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 1 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (COMBINED) – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 2 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (IN-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 3 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (RPPO DIFFERENTIAL DEDUCTIBLE) – BASE 1
CY 2010 PBP PRA Package – Section D
Page 4 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (RPPO DIFFERENTIAL DEDUCTIBLE) – BASE 2
CY 2010 PBP PRA Package – Section D
Page 5 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (RPPO DIFFERENTIAL DEDUCTIBLE) – BASE 3
CY 2010 PBP PRA Package – Section D
Page 6 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (OUT-OF-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 7 of 76
PBP 2010 Data Entry System Screens
SECTION D – PLAN DEDUCTIBLE (NON-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 8 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX ENROLLEE COST LIMIT (COMBINED) – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 9 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX ENROLLEE COST LIMIT (COMBINED) – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 10 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX ENROLLEE COST LIMIT (IN-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 11 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX ENROLLEE COST LIMIT (OUT-OF-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 12 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX ENROLLEE COST LIMIT (NON-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 13 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX PLAN BENEFIT COVERAGE SCREEN
CY 2010 PBP PRA Package – Section D
Page 14 of 76
PBP 2010 Data Entry System Screens
SECTION D – MAX PLAN BENEFIT COVERAGE (NON-NETWORK) SCREEN
CY 2010 PBP PRA Package – Section D
Page 15 of 76
PBP 2010 Data Entry System Screens
SECTION D –PLAN PREMIUM/ REBATE REDUCTION SCREEN
SECTION D – PFFS BALANCE BILLING SCREEN
CY 2010 PBP PRA Package – Section D
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PBP 2010 Data Entry System Screens
CY 2010 PBP PRA Package – Section D
Page 17 of 76
PBP 2010 Data Entry System Screens
SECTION D –MSA ANNUAL DEDUCTIBLE/DEPOSIT SCREEN
CY 2010 PBP PRA Package – Section D
Page 18 of 76
PBP 2010 Data Entry System Screens
SECTION D – MSA DEMO PLANS SCREEN
CY 2010 PBP PRA Package – Section D
Page 19 of 76
PBP 2010 Data Entry System Screens
SECTION D – NOTES SCREEN
CY 2010 PBP PRA Package – Section D
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PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL PACKAGE MANAGEMENT SCREEN
CY 2010 PBP PRA Package – Section D
Page 21 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – LABEL AND PREMIUM SCREEN
CY 2010 PBP PRA Package – Section D
Page 22 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – SERVICE CATEGORIES SCREEN
CY 2010 PBP PRA Package – Section D
Page 23 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7B – CHIROPRACTIC SERVICES – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 24 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7B – CHIROPRACTIC SERVICES – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 25 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7B – CHIROPRACTIC SERVICES – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 26 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7B – CHIROPRACTIC SERVICES – BASE 4 SCREEN
CY 2010 PBP PRA Package – Section D
Page 27 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 7B – CHIROPRACTIC SERVICES SCREEN
CY 2010 PBP PRA Package – Section D
Page 28 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7F – PODIATRY SERVICES – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 29 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7F – PODIATRY SERVICES – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 30 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 7F – PODIATRY SERVICES – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 31 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 7F – PODIATRY SERVICES SCREEN
CY 2010 PBP PRA Package – Section D
Page 32 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 10B – TRANSPORTATION – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 33 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 10B – TRANSPORTATION – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 34 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 10B – TRANSPORTATION – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 35 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 10B – TRANSPORTATION SERVICES SCREEN
CY 2010 PBP PRA Package – Section D
Page 36 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 37 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 38 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 39 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 4 SCREEN
CY 2010 PBP PRA Package – Section D
Page 40 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 5 SCREEN
CY 2010 PBP PRA Package – Section D
Page 41 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 6 SCREEN
CY 2010 PBP PRA Package – Section D
Page 42 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16A – PREVENTIVE DENTAL – BASE 7 SCREEN
CY 2010 PBP PRA Package – Section D
Page 43 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 16A – PREVENTIVE DENTAL SERVICES SCREEN
CY 2010 PBP PRA Package – Section D
Page 44 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 45 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 46 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 47 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 4 SCREEN
CY 2010 PBP PRA Package – Section D
Page 48 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 5 SCREEN
CY 2010 PBP PRA Package – Section D
Page 49 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 6 SCREEN
CY 2010 PBP PRA Package – Section D
Page 50 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 7 SCREEN
CY 2010 PBP PRA Package – Section D
Page 51 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 16B – COMPREHENSIVE DENTAL – BASE 8 SCREEN
CY 2010 PBP PRA Package – Section D
Page 52 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 16B – COMPREHENSIVE DENTAL SERVICES SCREEN
CY 2010 PBP PRA Package – Section D
Page 53 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17A – EYE EXAMS – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 54 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17A – EYE EXAMS – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 55 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17A – EYE EXAMS – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 56 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 17A – EYE EXAMS SCREEN
CY 2010 PBP PRA Package – Section D
Page 57 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17B – EYE WEAR – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 58 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17B – EYE WEAR – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 59 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17B – EYE WEAR – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 60 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17B – EYE WEAR – BASE 4 SCREEN
CY 2010 PBP PRA Package – Section D
Page 61 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17B – EYE WEAR – BASE 5 SCREEN
CY 2010 PBP PRA Package – Section D
Page 62 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 17B – EYE WEAR – BASE 6 SCREEN
CY 2010 PBP PRA Package – Section D
Page 63 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 17B – EYE WEAR SCREEN
CY 2010 PBP PRA Package – Section D
Page 64 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18A – HEARING EXAMS – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 65 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18A – HEARING EXAMS – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 66 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18A – HEARING EXAMS – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 67 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18A – HEARING EXAMS – BASE 4 SCREEN
CY 2010 PBP PRA Package – Section D
Page 68 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18A – HEARING EXAMS – BASE 5 SCREEN
CY 2010 PBP PRA Package – Section D
Page 69 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK - 18A – HEARING EXAMS SCREEN
CY 2010 PBP PRA Package – Section D
Page 70 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18B – HEARING AIDS – BASE 1 SCREEN
CY 2010 PBP PRA Package – Section D
Page 71 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18B – HEARING AIDS – BASE 2 SCREEN
CY 2010 PBP PRA Package – Section D
Page 72 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18B – HEARING AIDS – BASE 3 SCREEN
CY 2010 PBP PRA Package – Section D
Page 73 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18B – HEARING AIDS – BASE 4 SCREEN
CY 2010 PBP PRA Package – Section D
Page 74 of 76
PBP 2010 Data Entry System Screens
SECTION D – STEP-UP – 18B – HEARING AIDS – BASE 5 SCREEN
CY 2010 PBP PRA Package – Section D
Page 75 of 76
PBP 2010 Data Entry System Screens
SECTION D – OPTIONAL SUPPLEMENTAL – OUT-OF-NETWORK – STEP UP
CY 2010 PBP PRA Package – Section D
Page 76 of 76
| File Type | application/pdf |
| File Modified | 2008-12-19 |
| File Created | 2008-12-19 |