CY2013 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_2013_screenshots_section_c_2011_12_08

CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

OMB: 0938-0763

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PBP 2013 Data Entry System Screens

 
Section C- OON- General- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- General- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- General- Notes Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Inpatient- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Inpatient- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Inpatient- Base 3 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Inpatient- Base 4 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Skilled Nursing Facility- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Skilled Nursing Facility- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Number of Groups- Screen

 

Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Groups- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 29

PBP 2013 Data Entry System Screens

 
Section C- OON- Groups- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- General- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- General- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- General- Base 3 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- General- Base 4 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- General- Base 5 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- General- Notes Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Inpatient- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Inpatient- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Inpatient- Base 3 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Inpatient- Base 4 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Inpatient- Base 5 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Skilled Nursing Facility- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Skilled Nursing Facility- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Number of Groups- Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Groups- Base 1 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 27 of 29

PBP 2013 Data Entry System Screens

 
Section C- POS- Groups- Base 2 Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 28 of 29

PBP 2013 Data Entry System Screens

 
Section C- Visitor/Travel- General- US Screen

 
Fu Associates, Ltd.

 

CY 2013 PBP – Section C
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 29 of 29


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