Download:
pdf |
pdfPBP 2014 Data Entry System Screens
Medicare Rx General 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 63
PBP 2014 Data Entry System Screens
Medicare Rx General 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 63
PBP 2014 Data Entry System Screens
Medicare Rx General 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Tier 2 Model Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Tier 3 Model Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Tier 4 Model Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Tier 5 Model Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Tier 6 Model Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Medicare-Medicaid Formulary Tier Model 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Medicare-Medicaid Formulary Tier Model 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Medicare-Medicaid Formulary Tier Model 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Medicare-Medicaid Formulary Tier Model 5 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Medicare-Medicaid Formulary Tier Model 6 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 63
PBP 2014 Data Entry System Screens
Defined Standard – ICL and OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 63
PBP 2014 Data Entry System Screens
Actuarial Equivalent Characteristics Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 63
PBP 2014 Data Entry System Screens
Actuarial Equivalent – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Tier Type and Cost Share Structure – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Tier Locations – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Retail Pharmacy Location Supply – Pre-ICL Screen
Actuarially Equivalent – Mail Order Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – OON and LTC Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Retail Pharmacy Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Mail Order Copayment and Coinsurance - Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – OON and LTC Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Tier Type – Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 63
PBP 2014 Data Entry System Screens
Actuarially Equivalent – Tier Cost Sharing – Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 63
PBP 2014 Data Entry System Screens
Alternative – Deductible Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 63
PBP 2014 Data Entry System Screens
Alternative – Enhanced Alternative Characteristics Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 63
PBP 2014 Data Entry System Screens
Alternative – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Type and Cost Share Structure – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Locations – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 63
PBP 2014 Data Entry System Screens
Alternative – Retail Pharmacy Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 63
PBP 2014 Data Entry System Screens
Alternative – Mail Order Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 63
PBP 2014 Data Entry System Screens
Alternative – OON and LTC Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 63
PBP 2014 Data Entry System Screens
Alternative – Retail Pharmacy Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 63
PBP 2014 Data Entry System Screens
Alternative – Mail Order Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 63
PBP 2014 Data Entry System Screens
Alternative – OON and LTC Copayment and Coinsurance – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 63
PBP 2014 Data Entry System Screens
Alternative – Pre-ICL Medicare-Medicaid Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid Tier Type – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid Tier Locations – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid Retail Pharmacy Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid Mail Order Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid OON and LTC Location Supply – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid Copayment – Pre-ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 63
PBP 2014 Data Entry System Screens
Alternative – ICL Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 63
PBP 2014 Data Entry System Screens
Alternative – Gap Coverage Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Type and Cost Share Structure - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Coverage - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Locations - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 63
PBP 2014 Data Entry System Screens
Alternative – Retail Pharmacy Location Supply - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 50 of 63
PBP 2014 Data Entry System Screens
Alternative – Mail Order Location Supply - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 51 of 63
PBP 2014 Data Entry System Screens
Alternative – OON and LTC Location Supply - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 52 of 63
PBP 2014 Data Entry System Screens
Alternative – Retail Pharmacy Copayment and Coinsurance - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 53 of 63
PBP 2014 Data Entry System Screens
Alternative – Mail Order Copayment and Coinsurance - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 54 of 63
PBP 2014 Data Entry System Screens
Alternative – OON and LTC Copayment and Coinsurance - Gap Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 55 of 63
PBP 2014 Data Entry System Screens
Alternative – OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 56 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Type – Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 57 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Cost Sharing Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 58 of 63
PBP 2014 Data Entry System Screens
Alternative – Medicare-Medicaid Post-OOP Threshold Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 59 of 63
PBP 2014 Data Entry System Screens
Alternative – Tier Type and Tier Cost Sharing Post-OOP Medicare-Medicaid Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 60 of 63
PBP 2014 Data Entry System Screens
General Location/Supply Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 61 of 63
PBP 2014 Data Entry System Screens
Medicare Rx – Notes Screen
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 62 of 63
PBP 2014 Data Entry System Screens
Fu Associates, Ltd.
CY 2014 PBP – Section Rx
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 63 of 63
| File Type | application/pdf |
| File Title | PBP 2014 Data Entry System Screens |
| Author | keirle |
| File Modified | 2012-12-06 |
| File Created | 2012-12-06 |