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pdfPBP 2013 Data Entry System Screens
Section RX- Medicare RX General 1-- Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX General 2-- Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX General 3-- Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX – Tier 2 Model Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX – Tier 3 Model Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX – Tier 4 Model Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX – Tier 5 Model Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare RX – Tier 6 Model Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 49
PBP 2013 Data Entry System Screens
Section RX- Defined Standard – ICL and OOP Threshold Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent Characteristics – Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent – Tier Type and Cost Share Structure – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent – Tier Locations – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent – Retail Pharmacy Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent – Mail Order Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –Out-of-Network and Long Term Care Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –Retail Pharmacy Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –Mail Order Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –Out-of-Network and Long Term Care Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –OOP Threshold – Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –Tier Type – Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 49
PBP 2013 Data Entry System Screens
Section RX- Actuarially Equivalent –Tier Cost Sharing – Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – Deductible Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – Enhanced Alternative Characteristics Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Tier Type and Cost Share Structure – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Tier Locations – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Retail Pharmacy Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Retail Pharmacy Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Out-of-Network and Long Term Care Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Retail Pharmacy Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Mail Order Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Out-of Network and Long Term Care Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – ICL Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – Gap Coverage Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Tier Type and Cost Share Structure – Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Tier Coverage – Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Tier Locations – Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Retail Pharmacy Location Supply – Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Mail Order Location Supply – Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Out-of-Network and Long Term Care Location Supply – Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative-Retail Pharmacy Copayment and Coinsurance– Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative-Mail Order Copayment and Coinsurance– Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative- Out-of-Network and Long Term Care Copayment and Coinsurance– Gap Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – OOP Threshold Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative-Tier Type – Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 49
PBP 2013 Data Entry System Screens
Section RX- Alternative – Tier Cost Sharing Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 49
PBP 2013 Data Entry System Screens
Section RX- General Location and Supply – Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 49
PBP 2013 Data Entry System Screens
Section RX- Medicare Rx – Notes Screen
Fu Associates, Ltd.
CY 2013 PBP – Section RX
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 49
| File Type | application/pdf |
| Author | meyer |
| File Modified | 2011-12-09 |
| File Created | 2011-12-09 |