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CMS-R-262 #19 VBID/MA Uniformity Flexibility/SSBCI
ICR 202001-0938-005 · OMB 0938-0763 · Object 97806701.
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#19 VBID/MA Uniformity Flexibility/SSBCI Softrams 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 Softrams 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 Softrams 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 Softrams 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 Softrams 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 Softrams 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 Softrams 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 Softrams 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) Softrams 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) Softrams 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) Softrams 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) Softrams 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) Softrams 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) Softrams 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 Softrams 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 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 30 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits for VBID/UF/SSBCI – Package Type Softrams 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 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 32 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits for VBID/UF/SSBCI – Disease States: UF Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 33 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits for VBID/UF/SSBCI – MMP Benefits Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 34 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits 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 35 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits 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 36 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits for VBID/UF/SSBCI – Base 3 (Retroactive Reimbursement) Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 37 of 240 CY 2020 PBP Data Entry System Screens #19b Additional Benefits for VBID/UF/SSBCI - Notes # Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 38 of 240 #19c VBID Hospice- Base 1 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 39 of 240 #19c VBID Hospice- Base 2 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 40 of 240 #19c VBID Hospice- Base 3 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 41 of 240 #19c VBID Hospice- Base 4 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 42 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 43 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 44 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 45 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 46 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 47 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 48 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 7 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 49 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 8 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 50 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 9 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 51 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 10 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 52 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 11 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 53 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1a Inpatient Hospital-Acute – Base 12 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 54 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 55 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 56 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 57 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 58 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 59 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 60 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 7 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 61 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 8 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 62 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 9 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 63 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 10 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 64 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 11 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 65 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19A #1b Inpatient Hospital Psychiatric – Base 12 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 66 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 1 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 67 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 2 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 68 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 3 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 69 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 4 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 70 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 5 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 71 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 6 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 72 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 7 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 73 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 8 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 74 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 9 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 75 of 240 VBID/UF/SSBCI 19A #2 SNF – Base 10 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 76 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #10b Transportation Services – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 77 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #10b Transportation Services – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 78 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #10b Transportation Services – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 79 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13a Acupuncture – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 80 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13a Acupuncture – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 81 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13a Acupuncture – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 82 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13b OTC Items – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 83 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13b OTC Items – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 84 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13b OTC Items – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 85 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13c Meal Benefit – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 86 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13c Meal Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 87 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13c Meal Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 88 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13d Other 1 – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 89 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13d Other 1 – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 90 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13d Other 1 – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 91 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13e Other 2 – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 92 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13e Other 2 – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 93 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13e Other 2 – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 94 of 240 VBID/UF/SSBCI 19B #13f Other 3 – Base 1 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 95 of 240 VBID/UF/SSBCI 19B #13f Other 3 – Base 2 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 96 of 240 VBID/UF/SSBCI 19B #13f Other 3 – Base 3 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 97 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Non-Primarily Health Related Benefits for the Chronically III-Type Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 98 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Food and Produce – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 99 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Food and Produce – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 100 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Food and Produce – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 101 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Meals (beyond limited basis) – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 102 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Meals (beyond limited basis) – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 103 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Meals (beyond limited basis) – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 104 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Meals (beyond limited basis) – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 105 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Pest Control – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 106 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Pest Control – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 107 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Transportation for Non-Medical Needs – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 108 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Transportation for Non-Medical Needs – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 109 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Transportation for Non-Medical Needs – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 110 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Indoor Air Quality Equipment and Services – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 111 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Indoor Air Quality Equipment and Services – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 112 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Indoor Air Quality Equipment and Services – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 113 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Social Needs Benefit – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 114 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Social Needs Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 115 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Social Needs Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 116 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Complementary Therapies – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 117 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Complementary Therapies – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 118 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Complementary Therapies – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 119 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Services Supporting Self-Direction – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 120 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Services Supporting Self-Direction – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 121 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Services Supporting Self-Direction – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 122 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Structural Home Modifications – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 123 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Structural Home Modifications – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 124 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Structural Home Modifications – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 125 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i General Supports for Living – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 126 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i General Supports for Living – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 127 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i General Supports for Living - Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 128 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Non-Primarily Health Related Benefits for the Chronically III, Other Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 129 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 1 Non-Primarily Health Related Benefit – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 130 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 1 Non-Primarily Health Related Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 131 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 1 Non-Primarily Health Related Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 132 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 2 Non-Primarily Health Related Benefits – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 133 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 2 Non-Primarily Health Related Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 134 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 2 Non-Primarily Health Related Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 135 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 3 Non-Primarily Health Related Benefit – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 136 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 3 Non-Primarily Health Related Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 137 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 3 Non-Primarily Health Related Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 138 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 4 Non-Primarily Health Related Benefit – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 139 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 4 Non-Primarily Health Related Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 140 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 4 Non-Primarily Health Related Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 141 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 5 Non-Primarily Health Related Benefit – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 142 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 5 Non-Primarily Health Related Benefit – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 143 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #13i Other 5 Non-Primarily Health Related Benefit – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 144 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14b Annual Physical Exam – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 145 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14b Annual Physical Exam – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 146 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14b Annual Physical Exam – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 147 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 148 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 149 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 150 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 151 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 152 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 153 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 7 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 154 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 8 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 155 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 9 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 156 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 10 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 157 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 11 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 158 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 12 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 159 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 13 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 160 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 14 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 161 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #14c Other Defined Supplemental Benefits – Base 15 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 162 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16a Preventive Dental – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 163 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16a Preventive Dental – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 164 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16a Preventive Dental – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 165 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16a Preventive Dental – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 166 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16a Preventive Dental – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 167 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 168 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 169 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 170 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 171 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 172 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #16b Comprehensive Dental – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 173 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17a Eye Exams – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 174 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17a Eye Exams – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 175 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17a Eye Exams – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 176 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17b Eyewear – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 177 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17b Eyewear – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 178 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17b Eyewear – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 179 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17b Eyewear – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 180 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17b Eyewear – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 181 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #17b Eyewear – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 182 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18a Hearing Exams – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 183 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18a Hearing Exams – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 184 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18a Hearing Exams – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 185 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18a Hearing Exams – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 186 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18b Hearing Aids – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 187 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18b Hearing Aids – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 188 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18b Hearing Aids – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 189 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18b Hearing Aids – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 190 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #18b Hearing Aids – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 191 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 192 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 193 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 194 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #3 Cardiac and Pulmonary Rehabilitation Services – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 195 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #4c Worldwide Emergency/Urgent Coverage – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 196 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #4c Worldwide Emergency/Urgent Coverage – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 197 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #4c Worldwide Emergency/Urgent Coverage – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 198 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #7b Chiropractic Services – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 199 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #7b Chiropractic Services – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 200 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #7b Chiropractic Services – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 201 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #7f Podiatry Services – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 202 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #7f Podiatry Services – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 203 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #7f Podiatry Services – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 204 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #9d Outpatient Blood Services – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 205 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #9d Outpatient Blood Services – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 206 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 207 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 208 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 209 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 210 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 211 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 212 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 7 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 213 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 8 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 214 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 9 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 215 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 10 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 216 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 11 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 217 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1a Inpatient Hospital-Acute – Base 12 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 218 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 1 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 219 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 2 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 220 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 3 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 221 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 4 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 222 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 5 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 223 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 6 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 224 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 7 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 225 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 8 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 226 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 9 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 227 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 10 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 228 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 11 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 229 of 240 CY 2020 PBP Data Entry System Screens VBID/UF/SSBCI 19B #1b Inpatient Hospital Psychiatric – Base 12 Softrams CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 230 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 1 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 231 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 2 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 232 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 3 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 233 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 4 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 234 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 5 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 235 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 6 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 236 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 7 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 237 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 8 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 238 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 9 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 239 of 240 VBID/UF/SSBCI 19B #2 SNF – Base 10 Softrams CY 2020 PBP Data Entry System Screens CY2021 PBP – Section B VBID/UF/SSBCI 12/09/2019 CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING Page 240 of 240
| 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 |