R-262 #1a Inpatient Hospital-Acute – Base 1

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

APPENDIX_C_PBP2020_Screenshots-SectionB-2018-12-12

CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

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CY 2020 PBP Data Entry System Screens
#1a Inpatient Hospital-Acute – Base 1

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CY2020 PBP – Section B
12/12/2018
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#3 Cardiac and Pulmonary Rehabilitation Services – Base 1

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#4a Emergency Care/Post-Stabilization Care – Base 1

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#4b Urgently Needed Services – Base 1

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#4c Worldwide Emergency/Urgent Coverage – Base 1

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#5 Partial Hospitalization – Base 1

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#6 Home Health Services – Base 1

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#6 Home Health Services – MMP – Base 1

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#7a Primary Care Physician Services – Base 1

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#7b Chiropractic Services – Base 1

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#7b Chiropractic Services – Base 2

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#7c Occupational Therapy Services – Base 1

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#7d Physician Specialist Services – Base 1

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#7e Mental Health Specialty Services – Base 1

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#7f Podiatry Services – Base 1

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#7g Other Health Care Professional – 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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#7j Additional Telehealth Services – Base 1

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#7k Opioid Treatment Services – Base 1

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#7k Opioid Treatment Services – Base 2

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#8a Outpatient Diag Procs/Tests/Lab Services – Base 1

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#8b Outpatient Diag/Therapeutic Rad Services – 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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#9c Outpatient Substance Abuse – Base 3

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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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#12 Dialysis Services – Base 1

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#12 Dialysis Services – Base 2

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#13b OTC Items – Base 1

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File Typeapplication/pdf
File TitleCY 2020 PBP Data Entry System Screens
AuthorScott Meyer
File Modified2018-12-18
File Created2018-12-12

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