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 2014 screenshots_section_c_2012_12_03

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

OMB: 0938-0763

Document [pdf]
Download: pdf | pdf
PBP 2014 Data Entry System Screens

OON - General - Base 1 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 29

PBP 2014 Data Entry System Screens

OON - General - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 29

PBP 2014 Data Entry System Screens

OON - General - Notes Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 29

PBP 2014 Data Entry System Screens

OON - Inpatient - Base 1 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 29

PBP 2014 Data Entry System Screens

OON - Inpatient - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 29

PBP 2014 Data Entry System Screens

OON - Inpatient - Base 3 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 29

PBP 2014 Data Entry System Screens

OON - Inpatient - Base 4 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 29

PBP 2014 Data Entry System Screens

OON - SNF - Base 1 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 29

PBP 2014 Data Entry System Screens

OON – SNF - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 29

PBP 2014 Data Entry System Screens

OON - Number of Groups Screen

OON - Groups - Base 1 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 29

PBP 2014 Data Entry System Screens

OON – Groups - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 29

PBP 2014 Data Entry System Screens

POS - General - Base 1 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 29

PBP 2014 Data Entry System Screens

POS - General - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 29

PBP 2014 Data Entry System Screens

POS - General - Base 3 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 29

PBP 2014 Data Entry System Screens

POS - General - Base 4 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 29

PBP 2014 Data Entry System Screens

POS - General - Base 5 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 29

PBP 2014 Data Entry System Screens

POS - General - Notes Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 29

PBP 2014 Data Entry System Screens

POS - Inpatient - Base 1 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 29

PBP 2014 Data Entry System Screens

POS - Inpatient - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 29

PBP 2014 Data Entry System Screens

POS - Inpatient - Base 3 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 29

PBP 2014 Data Entry System Screens

POS - Inpatient - Base 4 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 29

PBP 2014 Data Entry System Screens

POS - Inpatient - Base 5 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 29

PBP 2014 Data Entry System Screens

POS – SNF - Base 1 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 29

PBP 2014 Data Entry System Screens

POS - SNF - Base 2 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 29

PBP 2014 Data Entry System Screens

POS - Number of Groups Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 29

PBP 2014 Data Entry System Screens

POS - Groups - Base 1 Screen
Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 29

PBP 2014 Data Entry System Screens

POS - Groups - Base 2 Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 27 of 29

PBP 2014 Data Entry System Screens

V/T - General - US Screen

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 28 of 29

PBP 2014 Data Entry System Screens

Fu Associates, Ltd.

CY 2014 PBP – Section C
12/6/2012
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 29 of 29


File Typeapplication/pdf
File TitlePBP 2014 Data Entry System Screens
Authorkeirle
File Modified2012-12-06
File Created2012-12-06

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