The changes to the claim filing time frame will occur in phases, with the initial phase effective on August 1, 2011. Learn More Auxiant is looking for great people like you to help our customers. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. To start your appeal, you (or your representative or your doctor) must contact us. Outside of member state of residence. × Check this box to appeal claims submitted after your contractual filing limits. Except where state law requires a longer time frame, the claim filing limit will change from 180 days to 90 days for participating health care professionals. We are continuing to operate under normal business hours and are here to assist. Filing a Single Level Review. Please attach the following medical necessity documentation: • Medical records • Lab reports • Radiology reports • Any other pertinent medical necessity documents . Cigna 90 days from DOS 180 days from original claim determination UHC 90 days from DOS 12 months from original claim determination Timely Filing Limits Cheat Sheet when to submit claims and appeals by payer *This information was based on information available online at the time this resource was developed. You can look in your “Evidence of Coverage” for information about how to file a grievance, contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) or click here for more information. Is there an extenuating circumstance that prevented Timely Filing to be filed within 120 days 799 Cromwell Park Drive. Non-contracted providers must include a Waiver of Liability and any information supporting the appeal. Please review the instructions for each category below to ensure proper routing of your appeal. ATTN: Appeals. service. Our payor number is 13162. Downey, CA 90242-7004. B St. Loui ments delays, v Ex He P.O. For UnitedHealthcare Community Plan, if your Claim Reconsideration … process. BOX 14162, READING, PA 19612-4162 (Claim form must be 800-390-3510. Claims that are not submitted within 180 days from the The SPD and the … If services are rendered on consecutive Box 30546 Their contact information will be on the notice of appeal sent to you. 1. ATTN: Appeals. Cigna providers2 must adhere to Cigna’s filing deadline guideline of 180 calendar days from the initial payment or denial. 180 days after the date of service. Since payer policies are not always readily Benefit Plan Administrators, Inc. (BPA) and Cigna Payor Solutions are pleased to announce new functionality and enhanced capabilities with over 990,000 Cigna Network Partners. Please call Member Services at 1-800-704-1484, TTY/TDD 1-800-255-0056 Monday through Friday from 8 a.m. to 7 p.m. Eastern time. Timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies.For example, if any patient getting services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement. decision is upheld, the provider is given instructions regarding submitting a formal appeal. If you have questions on claim status, you may also contact us at (413) 733-4540, or toll-free at (800) 633-7867, and select option 2. 22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Secondly, how do I file an appeal with Humana? Anthem Reduces Timely Filing Limit to 90 Days. Claims Filing Procedures. Timely Filing of U.S. Out -of Network & International Claims Cigna will consider claims for coverage under our plans when proof of loss (a claim) is submitted within one year (365 days) for U.S. Out-of-Network and International benefits after services are rendered. customary claim and appeal timely filing requirements during the COVID-19 “Outbreak Period” which continues from March 1, 2020 to March 1, 2021. Report Fraud and Abuse. Filing limit denial: Acceptable documentation for appeal When a claim has been denied because it was submitted beyond the filing limit, you may appeal our decision. 2021 HEALTH CARE PROFESSIONALS PROVIDER MANUAL MEDICARE ADVANTAGE 2021 Cigna Medicare Advantage Prov ider Manual PCOMM-2021-305 / INT_21_92475 This regulation pauses the timely filing requirements time clock for claims that would have exceeded the filing limitation during the national emergency period that began on March 1, 2020. Said plainly, the Rules “freeze” timely filing deadlines between arch 1, 2020 and arch 1, 2021. Exceptions Following is a list of exceptions to the 180-day timely filing limit standard for all Medica and SelectCare/LaborCare products (except when Medicare is the payer for Medica Select Solution or Medica We also included the timely filing limits for appeals, to make this tool actually useful. The denial MUST BE SUBMITTED along with the claim for payment consideration. Timely Filing Requirements. Mail the completed dispute form and letter of grievance/appeal along with all supporting documentation Physicians and other Professional Providers must submit a complete claim for any services provided to a member. Member Services: 800-464-4000. We have state-specific information about disputes and appeals. Please refer to the CDC for the most current updates on the coronavirus status, and we will continue to share updates as situations evolve and change. If you have a special need, we will give you extra help to file your appeal. April 14, 2021. Anthem is changing their timely filing limit for professional claims. In situations where a claim was denied for not being filed timely, the provider has 180 calendar days from the date the denial was received from another carrier as long as the claim was submitted within 180 calendar days of … SECONDARY FILING – must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier’s EOB. 1. This completed form and/or an appeal letter requesting an appeal review and indicating the reason(s) why you believe the claim payment is incorrect and should be changed. 90 days after the date of service. Auxiant's Integrated Buy Down product integrates with a client's fully insured benefit plan as a way to decrease the premium but limit the cost to the employee. Under Magellan's policies and procedures, the standard timely filing limit is 60 days (with a few state/plan exceptions ). 4205 Philips Farm Road, Suite 100. Submitting a secondary claim without a primary insurance EOB. A. Timely Filing of Out-of-Network Claims Cigna will consider claims for coverage under our plans when proof of loss (a claim) is submitted within one year (365 days) after services are rendered. c. Submitting a claim to commercial insurance for a work injury. Provider Appeal Form Instructions . Physicians and other Professional Providers must submit a complete claim for any services provided to a member. When the Plan member is traveling outside of their state of residence, submit all claims to: CIGNA Healthcare. Provider Appeals Procedures Appeals of Claims Denials or Adverse Decisions If you do not agree with the decision of the processed claim, you will have 365 days from the date of service or discharge to file an appeal. P.O. The insurance carrier denied 12031 as bundled with 11400. Provider Appeals ... • Since rejected claims are considered original claims , timely filing limits should be followed. As a Magellan network provider, what is my timely filing limit? Download a Form. 1. BCBS timely filing limit - Arkansas. in a timely fashion. Claims Submission – Timely Claims Filing Procedures - Effective April 21, 2008* HMO Blue Texas claims must be submitted within 180 days of the date of service. State-specific forms about disputes and appeals. File a Complaint. CLAIM INITIALLY FILED TO INCORRECT CARRIER – Appeal must be received at HealthSpring within 120 days from the date of the denial on the incorrect carrier’s EOB/RA (as long as the claim was initially filed to that carrier within 120 days of the date of service). As soon as a covered injury occurs, please complete the claim form in its entirety and mail to the address printed on the claim form: ATTN: SUPPLEMENTAL ACCIDENT UNIT, THE LOOMIS COMPANY, P.O. This means claims submitted on or after October 1, 2019 will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service 1. Appeal must be made within 60 days of original disallowed claim. Chattanooga, TN 37422. We also have a list of state exceptions to our 180-day filing standard. Beat Timely Filing Limit for Cigna Insurance reddit com April 20th, 2019 - Beat Timely Filing Limit for Cigna self Insurance submitted 1 year ago by ODimiBoy I have about 11 claims between Jan and July 2017 that should be covered by Cigna 9 Health Partners Provider Manual Provider Billing Need to change Dx or update appropriate modifier after consult with coding department. CIGNA will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA. Q. Our claims filing procedures are listed in detail in Section 5 of the Magellan National Provider Handbook (PDF). Under Magellan's policies and procedures, the standard timely filing limit is 60 days (with a few state/plan exceptions ). ... Attn: Appeals P.O. For UnitedHealthcare Community Plan, if your Claim Reconsideration … process. If you have questions about your filing limit please contact your contracting representative. Mail your Timely Filing appeal to: Molina Healthcare Attention: Claims Department 100 W. Big Beaver Road, Suite 600 Troy, MI 48084-5209 Or fax to : 248- 925- 1768 Attention Timely Filing appeal Code Edit Appeals (CCI Edits) CCI Edit appeals must be submitted with supporting documentation and medical notes/reports. TIMELY FILING Timely Filing Limits can be found in your SPD under the section titled “When Health laims Must e Filed” or you can contact the Customer Care team at the number listed on your ID card for assistance in determining your plan’s timely filing requirement. Include copy of letter/request received. SUBMITTING A CLAIM TO CIGNA. Write to us at: Blue Cross Community Health Plans. PO Box 188004. If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service. Timely filing should not stop you from chasing that insurance claim payment! ... Filing a claim cigna-healthspring appeal address. A denial received in the office for timely filing. Blue Cross Blue Shield of Arkansas timely filing limit: 180 days from the date of service. File medical claims on a Patient's Request for Medical Payment (DD Form 2642). If you need an expedited appeal or grievance process, call Humana Medical Plan at 1-888-259-6779 (TTY: 711). For example, if an insurance claim filing time frame is 90 days from the service date, the patient was treated on Jan 1 st, then the provider has to file the claim before 31st March. Filing Claims. d. Submitting a claim without medical records. Blue Cross and Blue Shield of Texas. The defendants then move for summary judgment as to 493 claims, arguing that the plaintiffs failed to exhaust their administrative appeals. For more information, contact Provider Services at 1-877-224-8230. What is timely filing limit in medical billing? BCBS timely filing limit - Arkansas. CMS does not require a specific form for non-contracted providers to submit a Medicare appeal. 3. 3. Claim Reconsideration Request Form – UnitedHealthcareOnline.com. QualCare offers affordable health plans and services for small groups, associations, businesses, public entities and large corporations. PCHP/PAS & PIC ONLY . Coding dispute Remittance Advice (RA), Explanation of Benefits (EOB), or other documentation of filing original claim. REVISION UPDATES: Update 11/2/2017 - Thanks to an obsevant attorney in New York, we have found two unfixed glitches in the calculation around when federal holidays occur vs. when they are observed. Furthermore, how long does it take Humana to review a claim? Paper Claims Send UB04 claims to: PO Box 933, New York, NY 10108-0933 Send CMS 1500 claims to: PO Box 1007, New York, NY 10108-1007 For […] AmeriHealth Caritas Pennsylvania Claims Filing Guide 2020 . electronically through a clearing house or Cigna-HealthSpring Claims Portal. Timely filing If services are rendered on consecutive days, such as for a Hospital Confinement, the limit will be counted from the last date of service. Blue Cross Blue Shield of Alabama timely filing limit for appeal: 180 days from the date you are notified. Filing limit denial: Acceptable documentation for appeal When a claim has been denied because it was submitted beyond the filing limit, you may appeal our decision. How to file your appeal. ASR App. Faxing is the preferred method for providers to submit Level I appeals to Blue Cross NC. You have the right to ask us to reconsider – and perhaps change – a determination decision by making an appeal. How to create an eSignature for the cigna appeals consent form. Providers may file a verbal or written complaint with the Missouri Care Complaints and Appeals Department. Attn: Complaints and Appeals Department. Please visit ValueOptions’ Web site for future updates Provider Network – Contracting and Credentialing Q. I currently participate with ValueOptions … If you are hearing impaired, call the Illinois Relay at 711. Under Magellan's policies and procedures, the standard timely filing limit is 60 days.This means that, subject to applicable state or federal laws, claims must be submitted to Magellan within 60 … Online resources. Timely filing of claims is 180 days from the date of service. Providers should contact Cigna at 800.CIGNA24 (800.244.6224) or use Cigna’s MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. Written appeals may be requested if exceptional circumstances prevented you from filing a claim. 96 Non – Covered charges. Time Limits • Filing limit appeals must be received within 60 days of the original BCBSRI EOP date. PO Box 7004. A denial is received in the office for timely filing. P.O. If YES - Please check box and continue on to question 2. Contact Us. You can send by mail or fax. Without knowing these timely filing limits, it is common for providers to submit claims outside of the timely filing limit and then receiving a denial for those claims. Appeals are divided into two categories: Clinical and Administrative. Timely filing requirements are not affected or changed by the appeal process or by the appeal outcome. If you do not speak English, we can provide an interpreter at no cost to you. Appeal must be made within 60 days of original disallowed claim. Note: Fee Schedule or reimbursement terms for multiple patients may not require individual appeals. Kaiser Permanente - Claims address. Optum is a national leader in providing physical medicine solutions to the health care market. As a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor (DOL), Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with … Claim Time Frames - Provider Connection - Blue Shield of California. 2. Filing limits. Box 2291. Need to refile the claim along with appeal letter and timely filing limit proof. Submit the appeal within 180 calendar days of the date of the initial payment or denial notice or, if the appeal relates to a payment that was adjusted by Cigna, within 180 calendar days from the date of the last payment adjustment, to the following address: If the ID … Use one of these methods: Call 1-800-462-3589 to talk with a Member Services representative Monday – Friday, 8 a.m. – 8 p.m. What is timely filing limit in medical billing? Register for MyBlue. For those of you using keywords to search, this list includes timely filing information for Blue Cross, Apple Care, Blue Shield, TriCare, Cigna, Health Net, Medicare, Medi-Cal, and a couple dozen others. Kaiser Permanente - HMO/DHMO/Senior Advantage Products. … This list does not limit application of the Corrected claims must be submitted within 365 days from the date of service. This regulation pauses the timely filing requirements time clock for claims that would have exceeded the filing limitation during the national emergency period that began on March 1, 2020. The Agreement permits CBH to deny claims submitted beyond that 60 day time period. Physicians and Providers may appeal how a claim processed, paid or denied. Chattanooga, TN 37422. You can reach the member advocate at 1-877-375-9097. Denials are usually due to incomplete or 1. Denver, CO 80246-0948. When submitting an appeal request of a denial to substantiate timely filing, please include the following: For paper claim submissions: The ERISA plans that governed those 493 claims unambiguously required the claimants to appeal adverse benefits determinations before filing their federal lawsuits. File the appeal with the Correct Appeal form and fill up all the details in it. RCM - Revenue Cycle Management guide is the useful healthcare information of United States. For those of you using keywords to search, this list includes timely filing information for Blue Cross, Apple Care, Blue Shield, TriCare, Cigna, Health Net, Medicare, Medi-Cal, and a couple dozen others. Appeal & Reconsideration Status Network Services Team (NST) 877-725-6525 Rejection Questions EDI Support Team EDISupport@CareCentrix.com Claims Inquiries Provider Portal: HomeBridge www.CareCentrixPortal.com Claims Status Reconsideration & Appeals Forms Register for EDI EFT & ERA Enrollment Provider Portal: HomeBridge® Appeal to the plan. Definition: ... Claims are not considered as received under timely filing guidelines if rejected for missing or invalid provider or member data. Claim Appeal Form For Claims Adjustments, see the online or fax Claim Adjustment Request form Claim Appeal requests include reconsideration of an adjudicated claim where the originally submitted data is accurate or a claim that was denied for timely filing. Update DEERS now! CBH gives providers an … A failed or returned claim submission is not considered valid proof of timely filing. Find My Login. CHAMPVA. Timely Filing of U.S. Out -of Network & International Claims Cigna will consider claims for coverage under our plans when proof of loss (a claim) is submitted within one year (365 days) for U.S. Out-of-Network and International benefits after services are rendered. SUBMITTING A CLAIM TO CIGNA. Appeal decisions are made within 30 days of receipt by CIGNA and written notification of the decision is sent to you via letter or EOP. A person or entity filing an appeal. Type of Appeal. If you have questions about your filing limit please contact your contracting representative. The Agreement permits CBH to deny claims submitted beyond that 60 day time period. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Healthful Living. 2. Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. ... Aetna Better Health TFL - Timely filing Limit: Initial Claims: 180 Days Resubmission: 365 Days from date of Explanation of Benefits Initial Filing Deadline 95 days from date of service Corrected Filing Deadline 120 days from the date of disposition Paper Claims with DOS prior to 11/1/2019 RightCare from Scott and White Health Plan Attn: Claims Appeals MS-A4-144 1206 West Campus Drive Temple, Texas 76502-9915 Paper Claims with DOS on/after 11/1/2019 Scott and White Health Plan ... Filing a claim service. You have the right to ask us to reconsider – and perhaps change – a determination decision by making an appeal. Filing Proc um claim ile claims w omplete st ode guidel ubmit claim e appropri ealthLink p he Payor d dvice repor nk encoura Except wo nk resulting He P.O. Q. Timely filing: The claim whose original reason for denial was untimely filing All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna ... Appeals and Payment Disputes Form for Cigna Medicare Advantage Providers in Arizona Columbia, MO 65201. This RCM guide is a free to use and contains useful information on Demo Entry, Medical Coding, Charge Entry, Claim Submission, Payment Posting and AR Follow Departments. Time Frames. Q. Durham, NC 27702-2291. The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Corrected claims are regarded as claims reconsiderations and are not considered claims appeals. Appeal & Reconsideration Status Network Services Team (NST) 877-725-6525 Rejection Questions EDI Support Team EDISupport@CareCentrix.com Claims Inquiries Provider Portal: HomeBridge www.CareCentrixPortal.com Claims Status Reconsideration & Appeals Forms Register for EDI EFT & ERA Enrollment Provider Portal: HomeBridge® WebTPA is actively monitoring the COVID-19 situation as it relates to our clients, members, partners and employees. Complaints should be addressed to: Missouri Care Health Plan. State exceptions to filing standard. Claims that are not submitted within 180 days from the Medica is the payer, the timely filing limit is 180 days after the date of service or date of discharge for inpatient claims. Denial code for timely filing limit expired is CO29 (The time limit for filing has expired). Timely Filing..... 31 Claim Format ... Mail Appeals to: Cigna Attn: Part C Appeals PO Box 24087 Nashville, TN 37202 Coding and Note: Reconsideration. A. 29 The time limit for filing has expired. There are two ways to file an appeal or grievance (complaint): Call Member Services at 1-877-860-2837. The filing limit for claims submission is 180 days from the date the services were rendered. If you have any questions, please contact your local network representative. CIGNA … The submitter report from Tufts Health Plan will confirm receipt of the claim as a CareLink claim. Beat Timely Filing Limit for Cigna Insurance reddit com April 20th, 2019 - Beat Timely Filing Limit for Cigna self Insurance submitted 1 year ago by ODimiBoy I have about 11 claims between Jan and July 2017 that should be covered by Cigna 9 Health Partners Provider Manual Provider Billing cigna-healthspring appeal form. In addition, the CMS Internet-Only Manual (IOM), Publication 100-04, Chapter 1 , Section 70.4 states, "When a claim is denied for having been filed after the timely filing period, such denial does not constitute an “initial determination”. Peach State Health Plan finds additional information is needed, and the delay is in your interest. Is there an extenuating circumstance that prevented Timely Filing to be filed within 120 days For help, call: 1-800-511-6943. The court agreed. cigna appeal fax number for providers. The payer has a 60-day timely filing policy for appeals. It's best to submit claims as soon as possible. Please find the below mentioned tips related to Timely Filing Appeal: 1. Federal Agencies Extend Timely Filing and Appeals Deadlines June 24, 2020. ** Note: Requirements are subject to change. Timely filing: The claim whose original reason for denial was untimely filing All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Sending claims in a timely manner In order to send a timely filing appeal, you have to have evidence to support your statement that the claim was sent within the timely filing deadline. For an Insurance company if the initial filing limit is 90 days, Claim being submitted after 90th day will be automatically denied by the system for Timely Filing. P.O. As always, you can appeal denied claims if you feel an appeal is warranted. Refer to member ID card for claims filing instructions or mail to: HealthSmart Benefit Solutions P.O. The filing limit for claims submission is 180 days from the date the services were rendered. If you use TTY telephone equipment, call us at 1-888-740-5670. Box 7490 Madison, WI 53707-7490. Contact the Cigna Customer Support Department at the toll-free number listed on the back of the Cigna customer's ID card to review any claim denials or payment decisions. These claims Cigna has a 90-day timely filing limit Medicaid has a 95 day timely filing limit UnitedHealthcare has a 90-day timely filing limit . PO Box 660717. Timely filing/late claim submission appeal Read more. BCBS of Alabama timely filing limit for filing an claims: 365 days from the date service provided. We also included the timely filing limits for appeals, to make this tool actually useful. Under Magellan's policies and procedures, the standard timely filing limit is 60 days.This means that, subject to applicable state or federal laws, claims must be submitted to Magellan within 60 … JHHC's objective is to process your claim in less than 30 days of receipt and 100% correctly. A. Provider Operations Manual Welcome to Optum® About Optum Congratulations, and welcome to OptumHealth Care Solutions, LLC (Optum). How to file your appeal. CORRECTED CLAIMS – must be received at Cigna-HealthSpring within180 days from the date on the initial Cigna-HealthSpring Remittance Advice. The exception to this timely filing rule pertains to USFHP: The timely filing of claims for USFHP is 90 days from the date on the COB EOB. For those of you using keywords to search, this list includes timely filing information for Blue Cross, Apple Care, Blue Shield, TriCare, Cigna, Health Net, Medicare, Medi-Cal, and a couple dozen others. Learn More. • Any claim with a date of service more than 60 days old will not be considered for filing limit appeal. For claims denied administratively (for example, timely filing) there is one level of appeal, except for states where regulatory requirements establish a different process. Practitioner/Provider Administrative Claim Reconsideration and Appeal Process Proof of Timely Filing In the event that a provider disputes the denial of an original claim for untimely filing, the provider must be able to show proof of submission within the filing deadline. Appeal should be sent to: Fax: 1-877-291-3248, or Email: UMR-Appeals@umr.com, or Mail: Claims Appeal Unit P.O. Making an appeal means making another try to get the medical care or prescription drug coverage you want. CHAMPVA. A determination is made within 30 days following receipt of an appeal that is accompanied by the appropriate documentation. Exceptions to the 180 day Timely Filing Requirement are as follows: • Claims received from a provider operated by a unit of local government with a population exceeding 3,000,000 when local government funds finance federal participation for claims payment – subject to a timely filing deadline of 12 months from date of service. Anywhere, anytime on your mobile device. CMS requires Medicare contractors to deny claims submitted after the timely filing limit. out-of-network claims submitted six (6) months [180 days] after the date of service. INSURANCE CLAIM TYPE TIMELY FILING LIMITS ... Aetna Appeals/Corrected Claims 180 days from date of denial or payment ... Cigna Appeals/Corrected claims 180 days from the date of denial or payment Healthsprings Initial Claim 120 days from DOS/ Secondary is 120 days from Primary eob date ASR Health Benefits - Home. Submit appeals to: Cigna Attn: Appeals Unit PO Box 24087 Nashville, TN 37202 Fax: 1-800-931-0149 . If the original decision is overturned, the claim will be reprocessed within 30 calendar days of the determination date. The payer has a 60-day timely filing policy for appeals. Written appeals may be requested if exceptional circumstances prevented you from filing a claim. If NO - File claim through normal process. Timely filing/late claim submission appeal Read more. Appeals & Grievances ... You can ask us to reconsider by filing a grievance with us. If NO - File claim through normal process. Call Us. Formal Claims Resolution Procedures (Appeal) Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share. For example, if you see your doctor on March 22, 2019, your doctor must file the Medicare claim for that visit no later than March 22, 2020. Provider Operations Manual Welcome to Optum® About Optum Congratulations, and welcome to OptumHealth Care Solutions, LLC (Optum). Claims Filing Procedures. Include . cigna provider dispute form. Fill in all 12 Blocks. Is the claim you’re appealing over 120 days from the Date of Service? BCBS of Alabama timely filing limit for filing an claims: 365 days from the date service provided. Appeals submitted beyond the filing limit will not be considered. for formal appeals or disputes as found in your provider manual or ….
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