CMS-R-262 PBP 2015 Data Entry System (section C screen shots)

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Appendix_C_PBP_2015_screenshots_section_c_2013_12_19

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

OMB: 0938-0763

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PBP	2015	Data	Entry	System	Screens	
 
OON – General – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 1 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – General – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 2 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – General – Notes 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 3 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Inpatient – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 4 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Inpatient – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 5 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Inpatient – Base 3 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 6 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Inpatient – Base 4 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 7 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – SNF – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 8 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – SNF – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 9 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Number of Groups 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 10 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Groups – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 11 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
OON – Groups – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 12 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – General – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 13 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – General – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 14 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – General – Base 3 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 15 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – General – Base 4 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 16 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – General – Base 5 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 17 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – General – Base 6 

 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 18 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Inpatient – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 19 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Inpatient – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 20 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Inpatient – Base 3 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 21 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Inpatient – Base 4 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 22 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Inpatient – Base 5 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 23 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – SNF – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 24 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – SNF – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 25 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Number of Groups 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 26 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Groups – Base 1 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 27 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
POS – Groups – Base 2 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 28 of 29

 

PBP	2015	Data	Entry	System	Screens	
 
V/T – General – US 

 
 
 

Fu Associates, Ltd.

 

CY 2015 PBP – Section C
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

 

Page 29 of 29

 


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File TitleMicrosoft Word - PBP_2015_screenshots_section_c_2013_12_19.docx
Authorbloss
File Modified2013-12-20
File Created2013-12-20

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