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pdfPBP2014 Data Entry System Screens
Plan Deductible LPPO/RPPO Base 1 – Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 66
PBP2014 Data Entry System Screens
Plan Deductible LPPO/RPPO Base 2 – Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 66
PBP2014 Data Entry System Screens
Plan Deductible LPPO/RPPO Base 3 – Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 66
PBP2014 Data Entry System Screens
Plan Deductible LPPO/RPPO Base 4 – Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 66
PBP2014 Data Entry System Screens
Plan Deductible LPPO/RPPO Base 5 – Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 66
PBP2014 Data Entry System Screens
Plan Deductible LPPO/RPPO Base 6 – Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 66
PBP2014 Data Entry System Screens
Plan Deductible (Combined) – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 66
PBP2014 Data Entry System Screens
Plan Deductible (Combined) – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 66
PBP2014 Data Entry System Screens
Plan Deductible (In-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 66
PBP2014 Data Entry System Screens
Plan Deductible (Out-of-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 66
PBP2014 Data Entry System Screens
Plan Deductible (Non-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 66
PBP2014 Data Entry System Screens
Max Enrolle Cost Limit (Combined) – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 66
PBP2014 Data Entry System Screens
Max Enrollee Cost Limit (Combined) – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 66
PBP2014 Data Entry System Screens
Max Enrollee Cost Limit (In-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 66
PBP2014 Data Entry System Screens
Max Enrollee Cost Limit (Out-of-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 66
PBP2014 Data Entry System Screens
Max Enrollee Cost Limit (Non-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 66
PBP2014 Data Entry System Screens
Max Plan Benefit Coverage Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 66
PBP2014 Data Entry System Screens
Max Plan Benefit Coverage (Non-Network) Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 66
PBP2014 Data Entry System Screens
Plan Premium/Rebate Reduction Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 66
PBP2014 Data Entry System Screens
PFFS Balance Billing Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 66
PBP2014 Data Entry System Screens
MSA Annual Deductible/Deposit Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 66
PBP2014 Data Entry System Screens
MMP - Medicaid/Plan covered cost sharing Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 66
PBP2014 Data Entry System Screens
Notes Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 66
PBP2014 Data Entry System Screens
Optional Supplemental – Management Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 66
PBP2014 Data Entry System Screens
Optional Supplemental – Label and Premium Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 66
PBP2014 Data Entry System Screens
Optional Supplemental – Service Categories Screen
Optional Supplemental – OON Stepup Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 66
PBP2014 Data Entry System Screens
Step Up #10b Transportation Services – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 66
PBP2014 Data Entry System Screens
Step Up #10b Transportation Services – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 66
PBP2014 Data Entry System Screens
Step Up #10b Transportation Services – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 66
PBP2014 Data Entry System Screens
Step Up #16a Preventive Dental – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 66
PBP2014 Data Entry System Screens
Step Up #16a Preventive Dental – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 66
PBP2014 Data Entry System Screens
Step Up #16a Preventive Dental – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 66
PBP2014 Data Entry System Screens
Step Up #16a Preventive Dental – Base 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 66
PBP2014 Data Entry System Screens
Step Up #16a Preventive Dental – Base 5 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 66
PBP2014 Data Entry System Screens
Step Up #16a Comprehensive Dental – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 66
PBP2014 Data Entry System Screens
Step Up #16a Comprehensive Dental – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 66
PBP2014 Data Entry System Screens
Step Up #16a Comprehensive Dental – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 66
PBP2014 Data Entry System Screens
Step Up #16a Comprehensive Dental – Base 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 66
PBP2014 Data Entry System Screens
Step Up #16a Comprehensive Dental – Base 5 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 66
PBP2014 Data Entry System Screens
Step Up #16a Comprehensive Dental – Base 6 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 66
PBP2014 Data Entry System Screens
Step Up #17a Eye Exams – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 66
PBP2014 Data Entry System Screens
Step Up #17a Eye Exams – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 66
PBP2014 Data Entry System Screens
Step Up #17a Eye Exams – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 66
PBP2014 Data Entry System Screens
Step Up #17b Eye Wear – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 66
PBP2014 Data Entry System Screens
Step Up #17b Eye Wear – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 66
PBP2014 Data Entry System Screens
Step Up #17b Eye Wear – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 66
PBP2014 Data Entry System Screens
Step Up #17b Eye Wear – Base 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 66
PBP2014 Data Entry System Screens
Step Up #17b Eye Wear – Base 5 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 66
PBP2014 Data Entry System Screens
Step Up #17b Eye Wear – Base 6 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 66
PBP2014 Data Entry System Screens
Step Up #18a Hearing Exams – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 50 of 66
PBP2014 Data Entry System Screens
Step Up #18a Hearing Exams – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 51 of 66
PBP2014 Data Entry System Screens
Step Up #18a Hearing Exams – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 52 of 66
PBP2014 Data Entry System Screens
Step Up #18a Hearing Exams – Base 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 53 of 66
PBP2014 Data Entry System Screens
Step Up #18b Hearing Aids – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 54 of 66
PBP2014 Data Entry System Screens
Step Up #18b Hearing Aids – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 55 of 66
PBP2014 Data Entry System Screens
Step Up #18b Hearing Aids – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 56 of 66
PBP2014 Data Entry System Screens
Step Up #18b Hearing Aids – Base 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 57 of 66
PBP2014 Data Entry System Screens
Step Up #18b Hearing Aids – Base 5 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 58 of 66
PBP2014 Data Entry System Screens
Step Up #7b Chiropratic Services – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 59 of 66
PBP2014 Data Entry System Screens
Step Up #7b Chiropratic Services – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 60 of 66
PBP2014 Data Entry System Screens
Step Up #7b Chiropratic Services – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 61 of 66
PBP2014 Data Entry System Screens
Step Up #7b Chiropratic Services – Base 4 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 62 of 66
PBP2014 Data Entry System Screens
Step Up #7f Podiatry Services – Base 1 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 63 of 66
PBP2014 Data Entry System Screens
Step Up #7f Podiatry Services – Base 2 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 64 of 66
PBP2014 Data Entry System Screens
Step Up #7f Podiatry Services – Base 3 Screen
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 65 of 66
PBP2014 Data Entry System Screens
Fu Associates, Ltd.
CY 2014 PBP – Section D
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 66 of 66
| File Type | application/pdf |
| File Title | PBP2014 Data Entry System Screens |
| Author | keirle |
| File Modified | 2012-12-06 |
| File Created | 2012-12-06 |