0000128369 00000 n Final Rule and Program Updates. %PDF-1.6 % . 0000129698 00000 n The ruling is effective on or after January 12, 2017 for CGM products covered by the ruling. benefits. The statute and regulations specify that the adjusted fee schedule amounts (50 percent of the blended phase in rates) must be updated each time new pricing information from the competitive bidding program becomes available, such as the recompeted Round 2 payment amounts that took effect on July 1, 2016. . See how a provider, office manager, or biller use Medusind to empower their practice. This final rule implements the requirements of section 16008 of the 21st Century Cures Act (for calendar years 2019 and 2020 only), which requires that certain information be considered in making fee schedule adjustments using competitive bidding information for items furnished on or after January 1, 2019. These policies are made available to provide information on certain Humana claims payment processes. 2015 Meetings. Administered by Humana Insurance Company. Humana legal entities that offer, underwrite, administer or insure insurance products and services. CMAC rates are determined by procedure code, ZIP Code, the setting where the services were rendered and the provider type. 0000130234 00000 n Effective for claims with dates of service on or after April 1, 2021, the fee schedule amounts for HCPCS codes E0424, E0431, E0433, E0434, E0439, E0441, E0442, E0443, E0444, E0447, E1390, E1391, E1392, E1405, E1406, and K0738 are adjusted to remove a percentage reduction necessary to meet the budget neutrality requirement previously mandated by section 1834(a)(9)(D)(ii) of the Act. This instruction provides contractor requirements for the implementation of section 16007 for claims with dates of service from July 1, 2016 through December 31, 2016. 0000128447 00000 n ( This reduction applies to all Medicare Advantage plans. lock 800 -448-6262. 3 routine cleanings per year at no additional cost. Contact; Site Map; Pages; In states, and for products where applicable, the premium may include a $1 administrative fee. Humana Hyatt Corporation IAC IBA IBEW Southwestern Health & Benefit Fund Idaho Pipe Trades These policies are guidelines only and do not constitute a benefit determination, medical advice, guarantee of payment, plan preauthorization, an Explanation of Benefits or a contract. Humana Individual dental and vision plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or Humana Health Benefit Plan of Louisiana, Inc. Discount plans offered by HumanaDental Insurance Company or Humana Insurance Company. For areas other than rural or non-contiguous areas, the fee schedules for certain DME and enteral nutrition codes will continue to be based on 100 percent of the adjusted fee schedule amounts from June 1, 2018 through December 31, 2018. In cases where accessories included in the 2008 CBP are furnished for use with base equipment that was not included in the 2008 CBP (e.g., manual wheelchairs, canes and aspirators), suppliers should append the KE modifier to the HCPCS code for the accessory beginning June 1, 2018, for beneficiaries residing in rural or non-contiguous, non-competitive bid areas. If you have purchased an association plan, an association fee may also apply. CMS issued aCY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care. KY Medicaid Fee-for-Service Behavioral Health & Substance Health (Just Now) WebOutpatient (Non-Facility) Fee Schedule Effective January 1, 2021 (revised 9/1/2021) Providers are expected to be familiar with State Plan Amendment covered servcies and https://www.chfs.ky.gov/agencies/dms/DMSFeeRateSchedules/BHOutpatientFFS2021.pdf %%EOF Benefit Program: . 0000137821 00000 n The rule also adjusts fee schedule amounts for former competitive bidding areas using competitive bidding pricing when there is a gap in the DMEPOS CBP. 2022 . These policies are subject to change or termination by Humana. Section 4315 of the Balanced Budget Act of 1997, which added section 1842(s) to the Social Security Act, authorizes a fee schedule for PEN, which was implemented on January 1, 2002. Written comments may either be emailed to DMEPOS@cms.hhs.gov or sent via regular mail to Elliot Klein, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop C5-03-17, Baltimore, MD 21244-1850. Operational Documents. More Articles About Humana Plans Humana Medicare Plan Reviews 0000054395 00000 n If you are one of the above, please either set up your payment by EFT or RCC. If the General Dentist's normal fee for any dental procedure is less than the fee listed on this . Sign up to get the latest information about your choice of CMS topics. Group Dental and Vision Plans (Insurance through your employer). On Wednesday, January 2, 2013, the President signed into law the American Taxpayer Relief Act of 2012. 0000037657 00000 n Please note that the non-rural fees for these KE codes will be set to zero on the files since KE is not a valid option in non-rural areas. For additional information, please go here. See the press release, PFS fact sheet, Quality Payment Program fact sheets, and Medicare Shared Savings Program fact sheet for provisions effective January 1, 2023. The Year 6 qualified provider list, available at the link below, will be updated after each reassessment. This commercial and Medicaid policy outlines Humana's billing requirements and reimbursement for state-supplied vaccines. The Medicare reimbursement rate is also referred to by Medicare as the Medicare Physician Fee Schedule (MPFS). (This fee is non-refundable as allowed by state). Get a quote or learn more about MedusindsPathology Billing and Practice Management solutions. Claims & Payments Fee Schedule Listing Fee Schedules Claim payment inquiries . Tell us about your business or organization and well connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. 72 In the event of a dispute, the policy as written in English is considered the controlling authority. 32.41 99421 3/9/2020 Online Digital Evaluation and Management Service, for an View CMAC rates Capital and direct medical education For New Mexico residents: Insured by Humana Insurance Company. Behavioral Health Overlay Services Fee Schedule. All claims must be submitted electronically in order to receive payment for services 98% of claims must be paid within 30 days and 100% within 90 days All claims for benefits must be filed no later than one year after the date the services were provided Claims processing and recoupments The worksheets that calculate the budget neutrality factors (ZIP) are also available. These policies are not intended to address every claim situation. 0000127520 00000 n PA required for rentals as indicated on the fee schedule. licensinghelp@tsbde.texas.gov. The professional component of clinical pathology is being increasingly cut out by most major commercial and governmental payors, and look for more payors to drop out in 2022. We will promptly process your voluntary disenrollment and will no longer reach out to set up payment. A minimum one-year, initial contract period may be required for some dental and vision plans, excluding Dental Savings Plus. Section 16007(a) of this new law extended the 6 month phase in period for adjusting DMEPOS fee schedule amounts using information from the competitive bidding program from June 30, 2016 to December 31, 2016. 2021 Health Plan List and Fee Schedule PO 71717 PHOENIX, AZ 85050 TEL 877.311.3338 FAX 602.485.3100 WWW.HNA-NET.COM 5 Food Giant Supermarkets, Inc. Ford Motor Company . Humana Physician News replaces Humanas YourPractice. 0000010693 00000 n %PDF-1.4 % Box 14611 Lexington, KY 40512-4611 CompBenefits claims office P.O. 0000129776 00000 n The Centers for Medicare & Medicaid Services (CMS) issued on February 10, 2017 Transmittal 3716, Change Request 9968 titled Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies Payment Rates under Section 16007 of the 21st Century Cures Act. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). 2018 Meetings. On May 11, 2108, CMS published an interim final rule with comment period (IFC) that increases the fee schedule rates for items furnished from June 1, 2018, through December 31, 2018, for certain durable medical equipment (DME) and enteral nutrition furnished in rural and non-contiguous areas of the country not subject to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP). 53. On the Eligibility and Benefits results, select the Patient Cost Estimator button at the top of the screen. All services must be medically necessary. If you need a more flexible plan, Humana's Dental High PPO plan might be right for you. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Cognitive Assessment & Care Plan Services, Office-Based Opioid Use Disorder (OUD) Treatment Billing, Medicare PFS Locality Configuration and Studies, Psychological and Neuropsychological Tests, Diagnostic Services by Physical Therapists, CY 2023 Medicare Physician Fee Schedule (PFS), Medicare Shared Savings Program fact sheet, Request for Information- Reducing Scope of Practice Burden (PDF), CY 2019 PFS Proposed Rule Documentation Requirements and Payment for Evaluation and Management Visits and Advancing Virtual Care (PDF), 1995 Documentation Guidelines For Evaluation and Management Services (PDF), Primary Care Incentive Program Payments for 2011 (PDF), 1997 Documentation Guidelines For Evaluation and Management Services (PDF), Place of Service Codes for Professional Claims (PDF), Primary Care Incentive Program Payments for 2012 (PDF), FAQ on Billing G0453 for Remote Intraoperative Neurophysiology Monitoring (PDF), FAQs for CR 7502: Medicares 3-Day Payment Window and the Impacts on Wholly Owned or Wholly Operated Physician Practices (PDF), Development of A Validation Model for RVUs (PDF), FAQ for Mammography Services - Updated 1/18/17 (PDF), Medicare FFS Physician Feedback Program/Value-Based Payment Modifier. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). TRICARE PRIME (JAN. 1-DEC. 31, 2021) Includes TRICARE Prime, TRICARE Prime Remote, the US Family Health Plan (USFHP), and TYA Prime plans. The ASC X12 837I standard transaction is used by institutional healthcare providers, including home health agencies, to bill Original Medicare. We strongly encourage all our providers we work with to request an annual fee schedule adjustment to match inflation. Humana legal entities that offer, underwrite, administer or insure insurance products and services. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. Humana Individual dental and vision plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or Humana Health Benefit Plan of Louisiana, Inc. Discount plans offered by HumanaDental Insurance Company or Humana Insurance Company. ) The prices for each procedure listed is the maximum amount providers will receive from the patient and/or Humana when filing claims for one of the Enhanced Benefit plans. Submitting the home health resource group (HHRG) with revenue code 023, Submitting the treatment authorization code (TAC), which is obtained through the Medicare OASIS system, Submitting the core-based statistical area (CBSA) where services were rendered (submitted with value code 61), Using an appropriate home health prospective payment system (PPS) bill type, Billing each visit on a separate claim line, Billing each visit with the appropriate CMS-designated revenue and Healthcare Common Procedure Coding System (HCPCS) code combinations, Billing units appropriate for the description of the HCPCS code (e.g., CMS visit G-codes represent 15-minute increments of service), Billing a claim line for nonroutine supplies (NRS) when the HHRG indicates NRS were provided, Billing CMS-required informational Q-codes. 0000000016 00000 n Humana careington dental fee schedule 2021. Duplication of Service Effective Date. The VA will typically reimburse providers at 100% of the CMAC fee schedule whereas Tricare will typically pay a percentage of the CMAC fee schedule. Identification #: N/A Date: 3/10/2021 Type: Memorandums The rule adjusts fee schedule amounts in rural and non-contiguous areas where competitive bidding has yet to be implemented using a 50/50 blend of competitive bidding pricing and historic (unadjusted) fee schedule amounts. 1877 0 obj <>/Filter/FlateDecode/ID[<66A0DCBA65916342A77F35338044ED7F>]/Index[1860 28]/Info 1859 0 R/Length 91/Prev 342597/Root 1861 0 R/Size 1888/Type/XRef/W[1 3 1]>>stream 0000054775 00000 n These policies are not intended to address every claim situation. On Availity Portal, you can access the benefit estimator through the Patient Cost Estimator button: As sequestration reductions have been imposed by the Centers for Medicare & Medicaid Services (CMS), Humana has implemented the same reductions to network and non-network provider payments. a. . CMS issued a CY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care. For Arizona residents: Insured by Humana Insurance Company. means youve safely connected to the .gov website. Go365 is not an insurance product. Humana Military 2023, administrator of the Department of Defense TRICARE East program. Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes. 0000128557 00000 n Section 627 of the Medicare Modernization Act of 2003 mandates fee schedule amounts for therapeutic shoes and inserts effective January 1, 2005, calculated using the P&O fee schedule methodology in section 1834(h) of the Social Security Act. The fee schedule amounts paid during this 2016 phase in period are based on 50 percent of the fee schedule amounts adjusted in accordance with Federal regulations at 42 CFR 414.210(g) and 50 percent of the unadjusted fee schedule amounts (i.e., 2015 fee schedule amounts updated by the 2016 covered item update). Medicare reimbursement rates refer to the amount of money that Medicare pays to doctors and other health care providers when they provide medical services to a Medicare beneficiary. 2022 Chiropractor Fee Schedule: PDF - Excel 2021 Chiropractor Fee Schedule. Enrollment in any Humana plan , Health (6 days ago) WebQuick Reference Guide for Horizon Behavioral HealthSM Providers Division of Developmental Disabilities (DDD) ,Horizon NJ Total Care/Dual Eligible Special Needs , https://www.beaconhealthoptions.com/wp-content/uploads/2017/01/FINAL-FOR-HNJH-WEBSITE-Horizon-Quick-Reference-Guide-MEDICARE-DDD-DSNP-MLTSS_v2.pdf, Health (1 days ago) Web1-800-991-5579 (for NJ State Health Benefits Program only) Address for claims submitted via paper: Horizon BCBSNJ Horizon Behavioral Health PO Box 10191 Newark, NJ , https://s21151.pcdn.co/wp-content/uploads/HBH_QRG_HBCBSNJ.pdf, Health (8 days ago) WebHorizon Behavioral Health PO Box 10191 Newark, NJ 07101-3189 Claims for FEP Members: PO Box 656: Newark, NJ 07101-0656: Claims for BlueCard Members: PO Box , https://www.beaconhealthoptions.com/wp-content/uploads/2016/11/Horizon-Quick-Reference-Guide-Participating-Providers_June-2017-updated.pdf, Apa citation for county health rankings, Aetna telehealth billing guidelines 2020, What stores accept united healthcare otc card, Worldwide leaders in healthcare publication, Mychart healthpartners park nicollet mn, Healtheconnections northeast georgia log in, 2021 health-improve.org. For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) DMEPOS suppliers, go to the DME Center (see under "Related Links" below). Our representatives are trained to answer many of your claims questions and can initiate contact with other Humana departments when further review or research is needed. IMPORTANT Rates: Back Cover Changes for 2022: Page 3 Summary of Benefits: Page 60 Serving: Alabama, the majority of Arizona, Arkansas, California, Colorado, District of Columbia, Florida, Georgia, the majority Claims submissions Claims mailing addresses HumanaDental claims office P.O. The revised MPFS conversion factor for CY 2021 is 34.8931. The fee schedule amounts for other areas where competitive bidding has yet to be implemented are adjusted using competitive bidding pricing only. Before applying for group coverage, please refer to the pre-enrollment disclosures for a description of plan provisions which may exclude, limit, reduce, modify or terminate your coverage. MPIP Year 6 Qualified Providers List: October 1, 2021- September 30, 2022 [11.97MB MS Excel] Due to the volume of adjustments anticipated, the contractors have been provided 6 months to complete all adjustments. See a, Establishes methodologies for adjusting the Medicare DMEPOS fee schedule amounts, Finalizes procedures for making benefit category determinations and payment determinations for DME and other new items and services under Medicare Part B, Classifies adjunctive continuous glucose monitors as DME under Medicare Part B, Finalizes certain DME payment provisions that were included in 2 interim final rules, Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule, worksheets that calculate the budget neutrality factors (ZIP), Revised blended fee schedule public use files for payment of claims from July 1, 2016 through December 31, 2016, 2017 fee schedule amounts for therapeutic CGMs (PDF), /Regulations-and-Guidance/Guidance/Transmittals/index, /Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule, Federal Register Notice: Public Meeting Regarding Inherent Reasonableness of Medicare Fee Schedule Amounts for Non-Mail Order (Retail) Diabetic Testing Supplies, CY 2009 Physician Fee Schedule (PFS) Final Rule with Comment: CMS-1403-FC Page 70163 (Final Rule and Associated Data Files). If you have purchased an association plan, an association fee may also apply. This includes a separate, higher paying class for oxygen generating portable equipment, as well as separate classes for delivery of portable and stationary portable oxygen contents created in 2006. Group A includes those retirees whose initial enlistment or appointment, or that of their sponsor's, occurred before January 1, 2018. 0000007158 00000 n Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday - Friday, 8 a.m. - 5 p.m., Central time. Claim payment inquiry resolution process guide, PDF 401 0 obj <> endobj xref It establishes a new methodology for ensuring that all new payment classes for oxygen and oxygen equipment are budget neutral in accordance with section 1834(a)(9)(D)(ii) of the Act. In addition, effective for items furnished on or after the date of implementation of the national mail order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program, the new law requires that the Medicare non-mail order fee schedule amounts for diabetic testing supplies be adjusted so that they are equal to the single payment amounts established under the national mail order competition for diabetic testing supplies. CMS issued theMedicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) final rule (CMS-1738-F, CMS-1687-F, and CMS-5531-F) that updates payment and benefit category policies and other provisions for DMEPOS items. 0000043937 00000 n Humana - (855) 852-7005 Molina- (800) 578-0775 WellCare of KY - (877) 389-9457 Report Fraud and Abuse (800) 372-2970 Regulations . Humana has announced 8 payment changes effective March 1, 2018 that will impact providers of outpatient physical, , https://gawendaseminars.com/humana-outpatient-therapy/, Health (5 days ago) WebSo lets say that you had an operation on a broken bone that costs $1000. Operational Documents. 401 73 07/01/2021 Rate Type FEE SCHEDULE $937.00 Provider Fee Schedules Use the below Fee Schedule Lookup tool to view provider reimbursement schedules. In states, and for products where applicable, the premium may include a $1 administrative fee. The revised MPFS conversion factor for CY 2021 is 34.8931. 0000128800 00000 n https:// 0000055029 00000 n These codes (A5210, S5210, W9040 and A7350) are not allowed as additional codes for extra benefit, either at point of pre-authorisation and at claims payment; the fee for pain relief is included in the main CCSD code. ( CMS Medicare FFS Provider e-News (March 8, 2013), Humana legal entities that offer, underwrite, administer or insure insurance products and services. The beneficiary is responsible for 20 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, plus any unmet deductible. Humana has full and final discretionary authority for their interpretation and application. /. Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday Friday, 8 a.m. 5 p.m., Central time. Revised blended fee schedule public use files for payment of claims from July 1, 2016 through December 31, 2016 in accordance with section 16007(a) of the Cures Act are now available. LOOING FOR. An official website of the United States government For group plans, please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description/Administrative Services Only) for more information on the company providing your benefits. Found at Availity.com. 2022 Humana Medicare Advantage full and partial networks private-fee-for-service (PFFS) plans Full and partial networks PFFS electronic claims flyer Full and partial networks PFFS FAQs Medicare Advantage PFFS plan model terms and conditions of payment 2021 and 2020 MA Materials (Archive) HMO 2021 HMO electronic claims flyer / 2021 HMO FAQs The 9.5 percent fee reduction only applies to these accessories when they are furnished for use with the base equipment included in the 2008 CBP. CMS issued the CY 2022 Medicare Physician Fee Schedule (PFS) final rule that updates payment policies, payment rates, and other provisions for services, effective January 1, 2022. If you have a coinsurance rate of 20%, you would be required to pay $200 for the cost of the operation, , https://www.claritychi.com/insurances/humana/, Health (3 days ago) WebHumana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. No supplier action is required to initiate the adjustments to correct payments for the 50/50 blended rate. These policies are subject to change or termination by Humana. HumanaDental Prepaid HS195 Plan with Implants The HumanaDental Prepaid plans focus on maintaining oral health, prevention and cost-containment. 0 To safeguard beneficiary access to necessary items and services, this rule increases the fee schedule amounts for certain DME and enteral nutrition in rural and noncontiguous areas to a blend of 50 percent of the fee schedule amounts that would have been paid from June 1, 2018, through December 31, 2018, had no adjustments been made and 50 percent of the adjusted fee schedule amounts. To take advantage of this tool, you must be a registered Availity Portal user. Not available with all Humana health plans. 0000126172 00000 n All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expired on December 31, 2018. 0000055350 00000 n 2022 CDT code changes. When compared to the 2020 fee schedule, rates have dropped over 5%, especially for the most common CPT codes which are highlighted in the chart. Humana Physician News replaces Humana's YourPractice. Resource sheet for healthcare providers, opens in new window In the event of any disagreement between this communication and the plan document, the plan document will control. Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc. New Mexico: Humana group dental and vision plans are insured by Humana Insurance Company. For group plans, please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description/Administrative Services Only) for more information on the company providing your benefits. 0000026662 00000 n 2019 Meetings. Get a quote or learn more about Medusinds, Pathology Billing and Practice Management solutions, Pathology Billing and Practice Management. hbbd```b``nd dL`X0{ fO @H~$? ? Commonwealth of KentuckyCabinet for Health and Family Services. 0000011992 00000 n trailer <<15AF1011AE294069AB0208556917077E>]/Prev 783763>> startxref 0 %%EOF 473 0 obj <>stream Box 14283 Lexington, KY 40512-4283 Electronic payer IDs Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. 0000015910 00000 n The DME and P&O fee schedule payment methodology is mandated by section 4062 of the Omnibus Budget Reconciliation Act (OBRA) of 1987, which added section 1834(a) to the Social Security Act. Select the Eligibility and Benefits Inquiry link to look up your patients coverage. This rule established a methodology for adjusting fee schedule amounts for certain items using information from the DMEPOS Competitive Bidding Program (CBP) for items furnished from January 1, 2019, thru December 31, 2020.
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