Form 1 Tribal Input

Centers for Medicare & Medicaid Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
I4-Tribal Input PRA document
Version 1.0
08/17/2017

Document Number: 194-QSSI-MACPro-PRA-I4-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. I4-Tribal Input – Screenshots .................................................................................. 1
1.1
1.2

Tribal Input – Path 1 ........................................................................................ 1
Tribal Input – Path 2 ........................................................................................ 4

List of Figures
Figure 1: Tribal Input – 1 ................................................................................................. 1
Figure 2: Tribal Input – 2 ................................................................................................. 1
Figure 3: Tribal Input – 3 ................................................................................................. 2
Figure 4: Tribal Input – 4 ................................................................................................. 2
Figure 5: Tribal Input – 5 ................................................................................................. 3
Figure 6: Tribal Input – 6 ................................................................................................. 3
Figure 7: Tribal Input – 7 ................................................................................................. 4
Figure 8: Tribal Input – 8 ................................................................................................. 4
Figure 9: Tribal Input – 9 ................................................................................................. 5
Figure 10: Tribal Input – 10 ............................................................................................. 5
Figure 11: Tribal Input – 11 ............................................................................................. 6
Figure 12: Tribal Input – 12 ............................................................................................. 6
Figure 13: Tribal Input – 13 ............................................................................................. 7
Figure 14: Tribal Input – 14 ............................................................................................. 7

I4-Tribal Input PRA document Version 1.0

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I4-Tribal Input – Screenshots

1. I4-Tribal Input – Screenshots
1.1

Tribal Input – Path 1

Figure 1: Tribal Input – 1

Figure 2: Tribal Input – 2

I4-Tribal Input PRA document Version 1.0

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I4-Tribal Input – Screenshots

Figure 3: Tribal Input – 3

Figure 4: Tribal Input – 4

I4-Tribal Input PRA document Version 1.0

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I4-Tribal Input – Screenshots

Figure 5: Tribal Input – 5

Figure 6: Tribal Input – 6

I4-Tribal Input PRA document Version 1.0

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I4-Tribal Input – Screenshots

Figure 7: Tribal Input – 7

1.2

Tribal Input – Path 2

Figure 8: Tribal Input – 8

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I4-Tribal Input – Screenshots

Figure 9: Tribal Input – 9

Figure 10: Tribal Input – 10

I4-Tribal Input PRA document Version 1.0

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I4-Tribal Input – Screenshots

Figure 11: Tribal Input – 11

Figure 12: Tribal Input – 12

I4-Tribal Input PRA document Version 1.0

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I4-Tribal Input – Screenshots

Figure 13: Tribal Input – 13

Figure 14: Tribal Input – 14

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