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pdfCY 2020 PBP Data Entry System Screens
#19 VBID/MA Uniformity Flexibility/SSBCI
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduction in Costs VBID/UF/SSBCI
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Package Type
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Disease States: VBID
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Disease States: UF
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – MMP Benefits
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 1 (Package Info)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 2 (OON/POS/Plan-level Deductible)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 3 (Reduced Coinsurance)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 4 (Reduced Coinsurance)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 5 (Reduced Coinsurance)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 6 (Reduced Coinsurance)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 7 (Reduced Coinsurance)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 8 (Reduced Deductible)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 9 (Reduced Deductible)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 10 (Reduced Copayment)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 11 (Reduced Copayment)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 12 (Reduced Copayment)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 13 (Reduced Copayment)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 14 (Reduced Copayment)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 15 (Reduced Specialist Coinsurance)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 16 (Reduced Specialist Deductible)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 17 (Reduced Specialist Copayment)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 18 (Retroactive Reimbursement)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 207
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Notes
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 6
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 7
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 8
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 9
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 10
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 11
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 12
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 6
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 7
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 8
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 9
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 10
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 11
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 12
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 50 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 51 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 52 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 53 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 54 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 6
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 55 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 7
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 56 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 8
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 57 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 9
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 58 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #2 SNF – Base 10
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 59 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 60 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Package Type
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 61 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Disease States: VBID
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 62 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Disease States: UF
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 63 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – MMP Benefits
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 64 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Base 1 (Package Info)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 65 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Base 2 (OON/POS/Plan-level Deductible)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 66 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Base 3 (Retroactive Reimbursement)
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 67 of 207
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Notes
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 68 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 69 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 70 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 71 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 72 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 73 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 6
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 74 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 7
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 75 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 8
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 76 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 9
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 77 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 10
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 78 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 11
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 79 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 12
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 80 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 83 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 84 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 85 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 6
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 86 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 7
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 87 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 8
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 88 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 9
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 89 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 10
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 11
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 91 of 207
CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 12
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 4
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 5
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 6
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 7
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 8
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 9
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #2 SNF – Base 10
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #4c Worldwide Emergency/Urgent Coverage – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #7b Chiropractic Services – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #7b Chiropractic Services – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #7b Chiropractic Services – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #7f Podiatry Services – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #7f Podiatry Services – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #7f Podiatry Services – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #9d Outpatient Blood Services – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #9d Outpatient Blood Services – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #10b Transportation Services – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #10b Transportation Services – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #10b Transportation Services – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13a Acupuncture – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13a Acupuncture – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13a Acupuncture – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13b OTC Items – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13b OTC Items – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13b OTC Items – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13c Meal Benefit – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13c Meal Benefit – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13c Meal Benefit – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13d Other 1 – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13d Other 1 – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13d Other 1 – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13e Other 2 – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13e Other 2 – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13e Other 2 – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13f Other 3 – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13f Other 3 – Base 2
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13f Other 3 – Base 3
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Non-Primarily Health Related Benefits for the Chronically Ill – Type
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Food and Produce – Base 1
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Food and Produce – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Food and Produce – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Home-Delivered Meals (beyond limited basis) – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Home-Delivered Meals (beyond limited basis) – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Home-Delivered Meals (beyond limited basis) – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Pest Control – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Pest Control – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Pest Control – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Transportation for Non-Medical Needs – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Transportation for Non-Medical Needs – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Transportation for Non-Medical Needs – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 1 Non-Primarily Health Related Benefit – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 1 Non-Primarily Health Related Benefit – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 1 Non-Primarily Health Related Benefit – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 2 Non-Primarily Health Related Benefit – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 2 Non-Primarily Health Related Benefit – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 2 Non-Primarily Health Related Benefit – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 3 Non-Primarily Health Related Benefit – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 3 Non-Primarily Health Related Benefit – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #13i Other 3 Non-Primarily Health Related Benefit – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14b Annual Physical Exam – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14b Annual Physical Exam – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14b Annual Physical Exam – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 3
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 4
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 6
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 7
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 8
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 9
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 10
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 11
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 12
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 13
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 14
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 15
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #16a Preventive Dental – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #16a Preventive Dental – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #16a Preventive Dental – Base 4
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CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #16a Preventive Dental – Base 5
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 1
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 2
Softrams
CY2020 PBP – Section B VBID/UF/SSBCI
12/12/2018
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File Type | application/pdf |
File Title | CY 2020 PBP Data Entry System Screens |
Author | Scott Meyer |
File Modified | 2018-12-18 |
File Created | 2018-12-12 |