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pdfPBP 2012 Data Entry System Screens
Section RX-Medicare RX General 1– Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 38
PBP 2012 Data Entry System Screens
Section RX-Medicare RX General 2– Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 38
PBP 2012 Data Entry System Screens
Section RX-Medicare RX General 3– Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 38
PBP 2012 Data Entry System Screens
Section RX-Defined Standard-ICL and OOP Threshold– Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent Characteristics– Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Tier Type Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Tier Label Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Tier Locations Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Cost Share Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Tier Coinsurance Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Pre-ICL Tier Copayment Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– OOP Threshold Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Post-OOP Threshold Tier Type Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 38
PBP 2012 Data Entry System Screens
Section RX-Actuarially Equivalent– Post-OOP Threshold Tier Label Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Deductible Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Enhanced Alternative Characteristics Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Tier Type Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Tier Label Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Tier Locations Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Tier Cost Share Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Tier Coinsurance Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Pre-ICL Tier Copayment Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– ICL Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Coverage Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Type Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Label Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Coverage Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Locations Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Cost Share Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Coinsurance Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Gap Tier Copayment Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– OOP Threshold Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Post-OOP Threshold Tier Type Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 38
PBP 2012 Data Entry System Screens
Section RX-Alternative– Post-OOP Threshold Tier Label Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 38
PBP 2012 Data Entry System Screens
Section RX-General Location/Supply Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 38
PBP 2012 Data Entry System Screens
Section RX-Medicare Rx-Notes Screen
Fu Associates, Ltd.
CY 2012 PBP – Section RX
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 38
File Type | application/pdf |
Author | meyer |
File Modified | 2010-12-06 |
File Created | 2010-12-06 |