CY2011 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_2012_screenshots_section_c__2010_12_03

CY2011 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

OMB: 0938-0763

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PBP 2012 Data Entry System Screens

 
Section C- OON- General- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- General- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- General- Notes Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- Inpatient- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- Inpatient- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- Inpatient- Base 3 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- Inpatient- Base 4 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- SNF- Base 1 Screen

 

Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- SNF- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON- Number of Groups Screen

 

Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON-Groups - Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 28

PBP 2012 Data Entry System Screens

 
Section C- OON-Groups - Base 2 Screen

Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 28

PBP 2012 Data Entry System Screens

 

 

Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-General - Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-General - Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-General - Base 3 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-General – Notes Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Inpatient – Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Inpatient – Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Inpatient – Base 3 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Inpatient – Base 4 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Inpatient – Base 5 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-SNF – Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-SNF – Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS– Number of Groups Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Groups – Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 28

PBP 2012 Data Entry System Screens

 
Section C- POS-Groups – Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 27 of 28

PBP 2012 Data Entry System Screens

 
Section C- V/T-General – US Screen

 
Fu Associates, Ltd.

 

CY 2012 PBP – Section C
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 28 of 28


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