CMS-R-262 CY 2018 PBP Data Entry System Screens - Section B

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Appendix_C_PBP_2018_ screenshots_section_b_2016_11_30_508

CY2018 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

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#1a Inpatient Hospital-Acute – Base 1

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#4a Emergency Care – Base 1

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#6 Home Health Services – Base 1

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#7d Physician Specialist Services – Base 1

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#7f Podiatry Services – Base 1

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#7h Psychiatric Services – Base 1

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#7i PT and SP Services – Base 1

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#7i PT and ST – MMP – Base 1

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#9a Outpatient Hospital Services – Base 1

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#9b ASC Services – Base 1

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#9b ASC Services – Base 2

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#9b ASC Services – Base 3

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#9c Outpatient Substance Abuse – Base 1

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#9c Outpatient Substance Abuse – Base 2

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#9d Outpatient Blood Services – Base 1

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#9d Outpatient Blood Services – Base 2

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#10a Ambulance Services – Base 1

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CY2018 PBP – Section B
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CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 112 of 250

#10a Ambulance Services – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 113 of 250

#10b Transportation Services – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 114 of 250

#10b Transportation Services – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 115 of 250

#10b Transportation Services – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 116 of 250

#11a DME – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 117 of 250

#11a DME – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 118 of 250

#11a DME – MMP – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 119 of 250

#11a DME – MMP – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 120 of 250

CY 2018 PBP Data Entry System Screens

#11b Prosthetics/Medical Supplies – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 121 of 250

CY 2018 PBP Data Entry System Screens

#11b Prosthetics/Medical Supplies – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 122 of 250

CY 2018 PBP Data Entry System Screens

#11b Prosthetics/Medical Supplies – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 123 of 250

CY 2018 PBP Data Entry System Screens

#11b Prosthetics/Medical Supplies – MMP – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 124 of 250

CY 2018 PBP Data Entry System Screens

#11c Diabetic Supplies and Services – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 125 of 250

CY 2018 PBP Data Entry System Screens

#11c Diabetic Supplies and Services – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 126 of 250

#12 Dialysis Services – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 127 of 250

#12 Dialysis Services – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 128 of 250

#13a Acupuncture – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 129 of 250

#13a Acupuncture – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 130 of 250

#13a Acupuncture – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 131 of 250

#13b OTC Items – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 132 of 250

#13b OTC Items – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 133 of 250

#13b OTC Items – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 134 of 250

#13c Meal Benefit – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 135 of 250

#13c Meal Benefit – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 136 of 250

#13c Meal Benefit – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 137 of 250

#13d Other 1 – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 138 of 250

#13d Other 1 – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 139 of 250

#13d Other 1 – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 140 of 250

#13e Other 2 – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 141 of 250

#13e Other 2 – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 142 of 250

#13e Other 2 – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 143 of 250

#13f Other 3 – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 144 of 250

#13f Other 3 – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 145 of 250

#13f Other 3 – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 146 of 250

CY 2018 PBP Data Entry System Screens

#13g Dual Eligible SNPs with Highly Integrated Services – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 147 of 250

CY 2018 PBP Data Entry System Screens

#13g Dual Eligible SNPs with Highly Integrated Services – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 148 of 250

CY 2018 PBP Data Entry System Screens

#13g Dual Eligible SNPs with Highly Integrated Services – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 149 of 250

#13h Additional Services – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 150 of 250

#13h Additional Services – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 151 of 250

#13h Additional Services – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 152 of 250

#13h Additional Services – Base 4

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 153 of 250

#13h Additional Services – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 154 of 250

#13h Additional Services – Base 6

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 155 of 250

#13h Additional Services – Base 7

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 156 of 250

#13h Additional Services – Base 8

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 157 of 250

#13h Additional Services – Base 9

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 158 of 250

#13h Additional Services – Base 10

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 159 of 250

#13h Additional Services – Base 11

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 160 of 250

#13h Additional Services – Base 12

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 161 of 250

#13h Additional Services – Base 13

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 162 of 250

#13h Additional Services – Base 14

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 163 of 250

#13h Additional Services – Base 15

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 164 of 250

#13h Additional Services – Base 16

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 165 of 250

#13h Additional Services – Base 17

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 166 of 250

#13h Additional Services – Base 18

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 167 of 250

#13h Additional Services – Base 19

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 168 of 250

#13h Additional Services – Base 20

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 169 of 250

#13h Additional Services – Base 21

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 170 of 250

#13h Additional Services – Base 22

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 171 of 250

#13h Additional Services – Base 23

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 172 of 250

#13h Additional Services – Base 24

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 173 of 250

#13h Additional Services – Base 25

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 174 of 250

#13h Additional Services – Base 26

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 175 of 250

#13h Additional Services – Base 27

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 176 of 250

#13h Additional Services – Base 28

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 177 of 250

#13h Additional Services – Base 29

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 178 of 250

#13h Additional Services – Base 30

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 179 of 250

CY 2018 PBP Data Entry System Screens

#14a Medicare-covered Zero Dollar Preventive Services

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 180 of 250

#14b Annual Physical Exam – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 181 of 250

#14b Annual Physical Exam – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 182 of 250

#14b Annual Physical Exam – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 183 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 184 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 185 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 186 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 4

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 187 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 5

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 188 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 6

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 189 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 7

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 190 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 8

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 191 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 9

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 192 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 10

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 193 of 250

CY 2018 PBP Data Entry System Screens

#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 11

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 194 of 250

CY 2018 PBP Data Entry System Screens

#14d Kidney Disease Education Services – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 195 of 250

CY 2018 PBP Data Entry System Screens

#14d Kidney Disease Education Services – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 196 of 250

CY 2018 PBP Data Entry System Screens

#14d Kidney Disease Education Services – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 197 of 250

CY 2018 PBP Data Entry System Screens

#14e Other Medicare-covered Preventive Services – Base 1

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 198 of 250

CY 2018 PBP Data Entry System Screens

#14e Other Medicare-covered Preventive Services – Base 2

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 199 of 250

CY 2018 PBP Data Entry System Screens

#14e Other Medicare-covered Preventive Services – Base 3

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 200 of 250

CY 2018 PBP Data Entry System Screens

#14e Other Medicare-covered Preventive Services – Base 4

Fu Associates, Ltd.

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 201 of 250

#15 Medicare Part B Rx Drugs – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 202 of 250

#15 Medicare Part B Rx Drugs – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 203 of 250

#15 Medicare Part B Rx Drugs – Notes

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 204 of 250

#15 Home Infusion Bundled Services

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 205 of 250

#16a Preventive Dental – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 206 of 250

#16a Preventive Dental – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 207 of 250

#16a Preventive Dental – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 208 of 250

#16a Preventive Dental – Base 4

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 209 of 250

#16a Preventive Dental – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 210 of 250

#16b Comprehensive Dental – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 211 of 250

#16b Comprehensive Dental – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 212 of 250

#16b Comprehensive Dental – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 213 of 250

#16b Comprehensive Dental – Base 4

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 214 of 250

#16b Comprehensive Dental – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 215 of 250

#16b Comprehensive Dental – Base 6

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 216 of 250

#17a Eye Exams – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 217 of 250

#17a Eye Exams – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 218 of 250

#17a Eye Exams – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 219 of 250

#17b Eyewear – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 220 of 250

#17b Eyewear – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 221 of 250

#17b Eyewear – Base 3

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 222 of 250

#17b Eyewear – Base 4

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 223 of 250

#17b Eyewear – Base 5

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 224 of 250

#17b Eyewear – Base 6

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 225 of 250

#18a Hearing Exams – Base 1

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
11/30/2016
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 226 of 250

#18a Hearing Exams – Base 2

Fu Associates, Ltd.

CY 2018 PBP Data Entry System Screens

CY2018 PBP – Section B
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File Typeapplication/pdf
File TitleCY 2018 PBP Data Entry System Screens - Section B
AuthorScott Meyer
File Modified2017-01-03
File Created2017-01-03

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