CMS-R-262 Section B-1A-Inpartient Hospital Acute-Base
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
Appendix C - PBP_2008_screenshots_sec_b1
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
OMB: 0938-0763
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:
Document [doc]
Download: doc | pdf
PBP 2008 Data Entry System Screens
Section B – 1a – Inpatient Hospital Acute – Base 1 Screen
Section B – 1a – Inpatient Hospital Acute – Base 2 Screen
Section B – 1a – Inpatient Hospital Acute – Base 3 Screen
Section B – 1a – Inpatient Hospital Acute – Base 4 Screen
Section B – 1a – Inpatient Hospital Acute – Base 5 Screen
Section B – 1a – Inpatient Hospital Acute – Base 6 Screen
Section B – 1a – Inpatient Hospital Acute – Base 7 Screen
Section B – 1a – Inpatient Hospital Acute – Base 8 Screen
Section B – 1a – Inpatient Hospital Acute – Base 9 Screen
Section B – 1a – Inpatient Hospital Acute – Base 10 Screen
Section B – 1a – Inpatient Hospital Acute (B Only) – Base 1 Screen
Section B – 1a – Inpatient Hospital Acute (B Only) – Base 2 Screen
Section B – 1a – Inpatient Hospital Acute (B Only) – Base 3 Screen
Section B – 1a – Inpatient Hospital Acute (B Only) – Base 4 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 1 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 2 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 3 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 4 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 5 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 6 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 7 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 8 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 9 Screen
Section B – 1b – Inpatient Psychiatric Hospital – Base 10 Screen
Section B – 1b – Inpatient Psychiatric Hospital (B Only) – Base 1 Screen
Section B – 1b – Inpatient Psychiatric Hospital (B Only) – Base 2 Screen
Section B – 1b – Inpatient Psychiatric Hospital (B Only) – Base 3 Screen
Section B – 1b – Inpatient Psychiatric Hospital (B Only) – Base 4 Screen
Section B – 1b – Inpatient Psychiatric Hospital (B Only) – Base 5 Screen
Page
| File Type | application/msword |
| File Modified | 2006-12-20 |
| File Created | 2006-12-20 |
© 2025 OMB.report | Privacy Policy