Easily obtain pre-authorization and eligibility information with our tools. Inpatient services and nonparticipating providers always require prior authorization. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Maine: Anthem Health Plans of Maine, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Your dashboard may experience future loading problems if not resolved. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Complete all member information fields on this form: Complete either the denial or the termination information section. Posted Jan. 11, 2021. State & Federal / Medicare. third-party website link available as an option to you, ABCBS does not in any way endorse any such website, Independent licensees of the Blue Cross and Blue Shield Association. We currently don't offer resources in your area, but you can select an option below to see information for that state. Some procedures may also receive instant approval. They may request or review medical records, test results and other information so they understand what services are being performed and are able to make an informed decision. You further agree that ABCBS and its Get Started In Kentucky: Anthem Health Plans of Kentucky, Inc. To stay covered, Medicaid members will need to take action. Learn more about electronic authorization. Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. Prior Authorization details for providers outside of WA/AK. Use Availity to submit prior authorizations and check codes. We also want to ensure you receive the right technology that addresses your particular clinical issue. P | Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), whichunderwrites or administersthe PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwritesor administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. This may result in a delay of our determination response. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. In Ohio: Community Insurance Company. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). It looks like you're outside the United States. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Step 5 In Medication / Medical and Dispensing Information, specify the medication name and indicate whether or not the request is a new therapy or a renewal (if renewal, specifythe date therapy started and the duration). Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. You can also refer to the provider manual for information about services that require prior authorization. Sign in to the appropriate website to complete your request. March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. | Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. In the event of an emergency, members may access emergency services 24/7. Important: Blueprint Portal will not load if you are using Internet Explorer. View the FEP-specific code list and forms. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. With convenience in mind, Care Centers are at the heart of the patient health journey. You can find the number on the back of your ID card, or you can write to us at the following address: Appeals and Grievance CoordinatorBlue Cross of IdahoPO Box 7408Boise, ID 83707. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In Ohio: Community Insurance Company. You are invited: Advancing Mental Health Equity for Youth & Young Adults. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. . 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. 2022 Electronic Forms LLC. Access eligibility and benefits information on the Availity Web Portal or Use the Prior Authorization Lookup Tool within Availity or Contact the Customer Care Center: Outside Los Angeles County: 1-800-407-4627 Inside Los Angeles County: 1-888-285-7801 Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. We currently don't offer resources in your area, but you can select an option below to see information for that state. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. ), 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed), 0466T Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Some procedures may also receive instant approval. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Ting Vit | Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, Step 1 At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Type at least three letters and we will start finding suggestions for you. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. View requirements for Basic Option, Standard Option and FEP Blue Focus. Once you choose to link to another website, you understand and agree that you have exited this FEP utilizes Magellan Rx Management for medical, Providers requesting prior approval for an ASE/PSE member should use the appropriate form on the, Providers who are requesting a prior approval for Walmart or other BlueAdvantage members should use the appropriate form from the, Providers who are requesting a prior approval for BlueMedicare or Health Advantage Medicare Advantage members should use the appropriate form from, Providers requesting prior approval for Part B drugs for BlueMedicare or Health Advantage Medicare should use the, Name and telephone number of contact person, Requesting / Performing Providers NPI or Provider ID, Copy of members insurance card (front/back), CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable, Please use the most descriptive procedure and diagnosis codes, Medical records to support requested services. Blueprint Portal is a members-only website that will help you understand and manage your health plan so youre able to find quality, patient-focused healthcare at the best possible price. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. FEP Basic Option/Standard OptionFEP Blue Focus. Non-individual members Use Availity to submit prior authorizations and check codes. Therefore, its important for you to know your benefits and covered services. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Visit Anthem.com to learn more about how we coordinate our medical and pharmacy benefits, review our drug lists, submit prior authorization requests, and more. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. In Kentucky: Anthem Health Plans of Kentucky, Inc. You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. In Ohio: Community Insurance Company. Let us know! | Sep 1, 2021 of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content website and are no longer accessing or using any ABCBS Data. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . | With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. The formcontains important information regarding the patients medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patients health care plan. | ), 0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. may be offered to you through such other websites or by the owner or operator of such other websites. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to Step 4 In Prescriber Information, specifythe prescribers full name, speciality, and full address. Sign in to the appropriate website to complete your request. In the case of a medical emergency, you do not need prior authorization to receive care. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. The Blue Cross name and symbol are registered marks of the Blue Cross Association. We look forward to working with you to provide quality service for our members. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. In Maine: Anthem Health Plans of Maine, Inc. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. Administrative. federal and Washington state civil rights laws. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. Tagalog | In Connecticut: Anthem Health Plans, Inc. Independent licensees of the Blue Cross and Blue Shield Association. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. Updated June 02, 2022. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Electronic authorizations. of all such websites. under any circumstances for the activities, omissions or conduct of any owner or operator of any other The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Kreyl Ayisyen | If you're concerned about losing coverage, we can connect you to the right options for you and your family. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Oromoo | Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Select Auth/Referral Inquiry or Authorizations. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Portugus | To learn more read Microsoft's help article. The resources for our providers may differ between states. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. Use of the Anthem websites constitutes your agreement with our Terms of Use. . Type at least three letters and well start finding suggestions for you. It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. | Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. The CarelonRx member services telephone number is 833-279-0458. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Please verify benefit coverage prior to rendering services. In Indiana: Anthem Insurance Companies, Inc. In Ohio: Community Insurance Company. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. In Indiana: Anthem Insurance Companies, Inc. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. Espaol | Review requirements for Medicare Advantage members. Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Do not sell or share my personal information. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 Use these lists to identify the member services that require prior authorization. Use of the Anthem websites constitutes your agreement with our Terms of Use. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. In the case of an emergency, you do not need prior authorization. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use the search tool to find the Care Center closest to you. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Choose your location to get started. | Prior approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. We look forward to working with you to provide quality services to our members. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. In Indiana: Anthem Insurance Companies, Inc. The site may not work properly. No, the need for emergency services does not require prior authorization. Expand All Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. If yes, provide the medication name, dosage, duration of therapy, and outcome. Out-of-area providers L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, L3925 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non-torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf. Do you offer telehealth services? In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. Medical Policy and Clinical Guideline updates are available on our provider website, AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update, Enhancing Provider News website and email communications, Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements, Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines, Specialty pharmacy updates - February 2023, City of Manchester Offers Medicare Advantage Option - New Hampshire, Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023, 2023 FEP benefit information available online, Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Fylnetra), Telephonic-only care allowance extended through April 11, 2023, Anthem Blue Cross and Blue Shield local precertification change in New Hampshire, Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines, New specialty pharmacy medical step therapy requirements, Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list, Notification regarding reimbursement changes to COVID-19 laboratory services codes, Submitting prior authorizations digitally through Interactive Care Reviewer, Outpatient facility revenue code billing requirements, AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update, Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List, Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines, Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines, Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change, Medical policy and clinical guideline updates available on our provider website, Federal Employee Program observation conversion for musculoskeletal cases, Remittance advice message enhancements: Providing clear descriptions and actionable next steps, Childhood Immunization Status and Lead Screening in Children for HEDIS, Attention lab providers: COVID-19 update regarding reimbursement, December 2022 Provider Newsletter - New Hampshire, Important information about utilization management, IngenioRx will become CarelonRx on January 1, 2023, Reimbursement policy retirement: Acupuncture Billed with Evaluation and Management - Professional, Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility, Reimbursement policy update: Bundled Services and Supplies - Professional, Manchester School District in New Hampshire moves to the Medicare Advantage plan with Anthem Blue Cross and Blue Shield, 2023 Medicare Advantage service area and benefit updates, Signature requirements for laboratory orders or requisitions, Reminder - updated AIM Musculoskeletal program effective January 1, 2023 - site of care reviews, Specialty pharmacy updates - December 2022, AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update, Member assessment of PCP after-hours messaging in 2022, Members assessment of behavioral healthcare after-hours messaging in 2022, CAA: Timely updates help keep our provider directories current, Clinical practice and preventive health guidelines available on anthem.com, Pharmacy information available on the provider website, PCP searches in Find Care - New Hampshire, Support documentation for AIM prior authorization requests, November 2022 Provider Newsletter - New Hampshire, Claims status message enhancements: providing clear descriptions and actionable next steps, Submit digital attachments within seven-calendar days for claims filed with a PWK segment indicator, You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too, Visit the Provider Learning Hub to view our latest learning opportunities, Correction to reimbursement policy: Place of Service - Facility, Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline, Medical policy and clinical guideline updates available on anthem.com, Medical drug benefit Clinical Criteria updates, Post office boxes being retired because of low usage, Specialty pharmacy updates - November 2022, CAA: Keep your provider directory information up to date, Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022, COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022, Register for our upcoming CME webinar about low back pain management, CME webinar about low back pain management - New Hampshire, October 2022 Provider Newsletter - New Hampshire.
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