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pdf#19 VBID/MA Uniformity Flexibility/SSBCI
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CY 2021 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 240
CY 2020 PBP Data Entry System Screens
#19 VBID Wellness and Health Care Planning
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 240
CY 2020 PBP Data Entry System Screens
#19 VBID Part C Rewards and Incentives # 1
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 240
CY 2020 PBP Data Entry System Screens
#19 VBID Part C Rewards and Incentives # 2
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 240
CY 2020 PBP Data Entry System Screens
#19 VBID Part C Rewards and Incentives # 3
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 240
#19a Reduction in Costs VBID/UF/SSBCI
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Package Type
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Target Population: VBID
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Disease States: UF
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – MMP Benefits
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 1 (Package Info)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 2 (OON/POS/Plan-level Deductible)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 3 (Reduced Coinsurance)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 4 (Reduced Coinsurance)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 5 (Reduced Coinsurance)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 6 (Reduced Coinsurance)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 7 (Reduced Coinsurance)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 8 (Reduced Deductible)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 9 (Reduced Deductible)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 10 (Reduced Copayment)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 11 (Reduced Copayment)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 12 (Reduced Copayment)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 13 (Reduced Copayment)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 14 (Reduced Copayment)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 15 (Reduced Specialist Coinsurance)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 16 (Reduced Specialist Deductible)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 17 (Reduced Specialist Copayment)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Base 18 (Retroactive Reimbursement)
Softrams
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 240
CY 2020 PBP Data Entry System Screens
#19a Reduced Cost Sharing for VBID/UF/SSBCI – Notes
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 240
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Package Type
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 240
CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Target Population: VBID
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Disease States: UF
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – MMP Benefits
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Base 1 (Package Info)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI -Base 2 (OON/POS/Plan-level Deductible)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI – Base 3 (Retroactive Reimbursement)
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
#19b Additional Benefits for VBID/UF/SSBCI - Notes
#
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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#19c VBID Hospice- Base 1
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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#19c VBID Hospice- Base 2
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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#19c VBID Hospice- Base 3
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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#19c VBID Hospice- Base 4
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 4
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 5
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 6
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 7
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 8
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 9
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 10
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 11
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 12
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 4
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 5
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 6
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 7
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 8
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 9
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 10
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 11
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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CY 2020 PBP Data Entry System Screens
VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 12
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19A #2 SNF – Base 1
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19A #2 SNF – Base 2
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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VBID/UF/SSBCI 19A #2 SNF – Base 3
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19A #2 SNF – Base 4
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19A #2 SNF – Base 5
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19A #2 SNF – Base 6
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19A #2 SNF – Base 7
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19A #2 SNF – Base 8
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19A #2 SNF – Base 9
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19A #2 SNF – Base 10
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CY 2020 PBP Data Entry System Screens
CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #10b Transportation Services – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #10b Transportation Services – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #10b Transportation Services – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13a Acupuncture – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13a Acupuncture – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13a Acupuncture – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13b OTC Items – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13b OTC Items – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13b OTC Items – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19B #13c Meal Benefit – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13c Meal Benefit – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13c Meal Benefit – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19B #13d Other 1 – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
12/09/2019
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VBID/UF/SSBCI 19B #13d Other 1 – Base 2
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13d Other 1 – Base 3
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CY2021 PBP – Section B VBID/UF/SSBCI
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VBID/UF/SSBCI 19B #13e Other 2 – Base 1
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CY2021 PBP – Section B VBID/UF/SSBCI
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| File Type | application/pdf |
| File Title | CY 2021 PBP Data Entry System Screens |
| Author | Softrams |
| File Modified | 2019-12-09 |
| File Created | 2019-12-09 |