R-262 OON – General – 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-SectionC-2018-12-12

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

OMB: 0938-0763

Document [pdf]
Download: pdf | pdf
CY 2020 PBP Data Entry System Screens
OON – General – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 29

CY 2020 PBP Data Entry System Screens
OON – General – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 29

CY 2020 PBP Data Entry System Screens
OON – General – Notes

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 29

CY 2020 PBP Data Entry System Screens
OON – Inpatient – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 29

CY 2020 PBP Data Entry System Screens
OON – Inpatient – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 29

CY 2020 PBP Data Entry System Screens
OON – Inpatient – Base 3

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 29

CY 2020 PBP Data Entry System Screens
OON – Inpatient – Base 4

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 29

CY 2020 PBP Data Entry System Screens
OON – SNF – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 8 of 29

CY 2020 PBP Data Entry System Screens
OON – SNF – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 9 of 29

CY 2020 PBP Data Entry System Screens
OON – Number of Groups

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 10 of 29

CY 2020 PBP Data Entry System Screens
OON – Groups – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 11 of 29

CY 2020 PBP Data Entry System Screens
OON – Groups – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 12 of 29

CY 2020 PBP Data Entry System Screens
POS – General – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 13 of 29

CY 2020 PBP Data Entry System Screens
POS – General – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 14 of 29

CY 2020 PBP Data Entry System Screens
POS – General – Base 3

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 15 of 29

CY 2020 PBP Data Entry System Screens
POS – General – Base 4

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 16 of 29

CY 2020 PBP Data Entry System Screens
POS – General – Base 5

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 17 of 29

CY 2020 PBP Data Entry System Screens
POS – General – Base 6

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 18 of 29

CY 2020 PBP Data Entry System Screens
POS – Inpatient – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 19 of 29

CY 2020 PBP Data Entry System Screens
POS – Inpatient – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 20 of 29

CY 2020 PBP Data Entry System Screens
POS – Inpatient – Base 3

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 21 of 29

CY 2020 PBP Data Entry System Screens
POS – Inpatient – Base 4

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 22 of 29

CY 2020 PBP Data Entry System Screens
POS – Inpatient – Base 5

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 23 of 29

CY 2020 PBP Data Entry System Screens
POS – SNF – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 24 of 29

CY 2020 PBP Data Entry System Screens
POS – SNF – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 25 of 29

CY 2020 PBP Data Entry System Screens
POS – Number of Groups

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 26 of 29

CY 2020 PBP Data Entry System Screens
POS – Groups – Base 1

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 27 of 29

CY 2020 PBP Data Entry System Screens
POS – Groups – Base 2

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 28 of 29

CY 2020 PBP Data Entry System Screens
V/T – General – US

Softrams

CY2020 PBP – Section C
12/12/2018
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 29 of 29

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

© 2024 OMB.report | Privacy Policy