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pdfPBP 2012 Data Entry System Screens
Section D-Plan Deductible (Combined) - Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Deductible (Combined) - Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Deductible (In-Network) - Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Deductible (RPPO-Differential Deductible) – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Deductible (RPPO-Differential Deductible) – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Deductible (RPPO-Differential Deductible) – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Deductible (Out-of-Network) – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 63
PBP 2012 Data Entry System Screens
Section D-Max Enrollee Cost Limit (Combined) – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 63
PBP 2012 Data Entry System Screens
Section D-Max Enrollee Cost Limit (Combined) – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 63
PBP 2012 Data Entry System Screens
Section D-Max Enrollee Cost Limit (In-Network) – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 63
PBP 2012 Data Entry System Screens
Section D-Max Enrollee Cost Limit (Out-of-Network) – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 63
PBP 2012 Data Entry System Screens
Section D-Max Enrollee Cost Limit (Non-Network) – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 63
PBP 2012 Data Entry System Screens
Section D-Max Plan Benefit Coverage – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 63
PBP 2012 Data Entry System Screens
Section D-Max Plan Benefit Coverage (Non-Network) – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 63
PBP 2012 Data Entry System Screens
Section D-Plan Premium/Rebate Reduction – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 63
PBP 2012 Data Entry System Screens
Section D-PFFS Balance Billing – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 63
PBP 2012 Data Entry System Screens
Section D-MSA Annual Deductible/Deposit – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 63
PBP 2012 Data Entry System Screens
Section D-Notes – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 63
PBP 2012 Data Entry System Screens
Section D-Optional Supplemental– Management Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 63
PBP 2012 Data Entry System Screens
Section D-Optional Supplemental– Label and Premium Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 63
PBP 2012 Data Entry System Screens
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 63
PBP 2012 Data Entry System Screens
Section D-Optional Supplemental– Services Categories Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 63
PBP 2012 Data Entry System Screens
Section D-Optional Supplemental– OON Stepup Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 63
PBP 2012 Data Entry System Screens
Section D-Optional Supplemental– OON Optional Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7B Chiropractic Services– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7B Chiropractic Services– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7B Chiropractic Services– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7B Chiropractic Services– Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7F Podiatry Services– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7F Podiatry Services– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 7F Podiatry Services– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 10B Transportation Services– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 10B Transportation Services– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 10B Transportation Services– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16A Preventative Dental– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16A Preventative Dental– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16A Preventative Dental– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16A Preventative Dental– Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16A Preventative Dental– Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16B Comprehensive Dental– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16B Comprehensive Dental– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16B Comprehensive Dental– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16B Comprehensive Dental– Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16B Comprehensive Dental– Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 16B Comprehensive Dental– Base 6 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17A Eye Exams– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17A Eye Exams– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17A Eye Exams– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17B Eye Wear– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17B Eye Wear– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 50 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17B Eye Wear– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 51 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17B Eye Wear– Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 52 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17B Eye Wear– Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 53 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 17B Eye Wear– Base 6 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 54 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18A Hearing Exams– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 55 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18A Hearing Exams– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 56 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18A Hearing Exams– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 57 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18A Hearing Exams– Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 58 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18B Hearing Aids– Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 59 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18B Hearing Aids– Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 60 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18B Hearing Aids– Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 61 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18B Hearing Aids– Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 62 of 63
PBP 2012 Data Entry System Screens
Section D-Step Up 18B Hearing Aids– Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section D
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 63 of 63
| File Type | application/pdf |
| Author | meyer |
| File Modified | 2010-12-06 |
| File Created | 2010-12-06 |