AmeriHealth Caritas North Carolina . Home | NC Medicaid Adult Medicaid. Provider Enrollment | NC Medicaid EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) AND HEALTH CHECK. We understand that maintaining a healthy community starts with providing care to those who need it most. North Carolina Division of Social Services DSS-5027 Services Information System (SIS) User's Manual 06-20-2023 . Secure websites use HTTPS certificates. Providers must provide services only after they are enrolled as an NC Medicaid or NC Health Choice (NCHC) provider. Policies/Manuals; Administrative Letters; Change Notices; . Implementation Date for the New Records Management and Documentation Manual . Customer Service Center: 1-800-662-7030 Visit RelayNC for information about TTY services. Last Updated. NC Medicaid Contact Center Phone: 888-245-0179 Email: Medicaid.DMErequest@dhhs.nc.gov. The first notification is sent to the providers Message Center Inbox 70 days prior to the provider re-credentialing due date. REFUGEE HEALTH ASSESSMENTS PROVIDED IN HEALTH DEPARTMENTS. To streamline processes for nursing facility admissions and the determination of long-term care financial eligibility, NC Medicaid created a new standardized PHP Notification of Nursing Facility Level of Care Form (NC Medicaid-2039) for PHPs and nursing facilities to communicate with local Departments of Social Services (DSS). Active Provider Recredentialing Due - August - December 2019. 2 . What Are Activities of Daily Living . This notice has information about a Jan. 13, 2023, court hearing on whether to approve the proposed Settlement Agreement. 2 . Secure websites use HTTPS certificates. To notify CCH of pregnancy, please complete the Pregnancy Risk Screening Tool from NC DHHS available through the link below and fax to Carolina Complete Health Care Management Notification of Pregnancy:833-417-0446. The preferred method to submit PA requests is online via the NCTracks Provider Portal. An official website of the State of North Carolina. Providers will be suspended if the re-credentialing application is not submitted by their re-credentialing due date. MA-2220 STATE RESIDENCY. New Medicaid Bulletin Articles Available as of June 27 A lock icon or https:// means youve safely connected to the official website. NC Medicaidwill consider specific requests for retroactive effective dates if: NC Medicaidcannot provide special consideration for processing of enrollment applications due to provider error, incomplete information, or due to a delay in obtaining credentialing, endorsement or licensure information from another agency. Any documents and items offered in electronic format can be requested in paper format. Contact Information. To learn more, view our full privacy policy. Studies show that taking your blood pressure at least twice a month for four months lowers your blood pressure. For billing information specific to a program or service, refer to theClinical Coverage Policies. PDF 2023 Provider Manual - Carolina Complete Health 515 North State Street, Chicago, Illinois, 60610. The Settlement provides important protections for North Carolina Medicaid beneficiaries. The provider will complete an abbreviated application, Credentialing and background checks will be required, Fingerprint-based criminal background checks, if applicable, There is no application fee for lite-enrollment, The provider will complete a full-enrollment application, The provider is required to complete re-verification every five years, The provider will be required to pay the $100 NC application fee during enrollment and re-verification. Customer Service Center:1-800-662-7030 A lock icon or https:// means youve safely connected to the official website. The four-month YMCA BPSM program offers personal support for members to build skills that help them manage high blood pressure, notice and control triggers that raise blood pressure, and eat healthier. . Provider Ombudsman For provider inquiries, concerns, complaints regarding health plans Medicaid.ProviderOmbudsman@dhhs.nc.gov Phone: 866-304-7062 NCTracks Call Center Phone: 800-688-6696 Health Plan Contacts and Resources Policies/Manuals; Administrative Letters; Change Notices; Eligibility Information System - EIS. NC Medicaid . Manuals, Forms, and Guides - Carolina Complete Health A lock icon or https:// means youve safely connected to the official website. The NC Medicaid Enrollment Broker provides services to help NC Medicaid beneficiaries learn about their NC Medicaid health care options, find information about health care options and primary care providers, and enroll in a health care option. If you have questions, you can call AmeriHealth Caritas North Carolina Provider Services at 1 . transmit authorization to service providers to claim reimbursement for services . To request an aid or service, please call Carolina Complete Health Member Services at1-833-552-3876 (TTY 711). Get started. If anOOS provider chooses to enroll using the lite-enrollment application, the following will apply: If an OOSprovider chooses to enroll using the full-enrollment application, the following will apply: Note: A provider has the option to change from lite enrollment to full enrollment by submitting a Manage Change Request (MCR). An official website of the State of North Carolina An official website of NC How you know . State Government websites value user privacy. NC Department of Health and Human Services Wellcare of North Carolina; Find a Provider; Member Login; Help Center; Providers. . MA-2160 QUALIFIED INDIVIDUAL - MQB-E. MA-2170 FAMILY PLANNING PROGRAM. To learn more, view our full privacy policy. PDF Claims and Billing Manual - AmeriHealth Caritas North Carolina Helpful resources. This guide explains the services that WellCare offers to help with Wellcare partners with providers to give members high-quality, low-cost health care and we know that having a healthy community starts with those who need it most. Participants cannot have had a recent cardiac event, have atrial fibrillation or other arrhythmias, or be at risk for lymphedema. Contact. Families. Family and Children's Medicaid. Secure websites use HTTPS certificates. Forms for Durable Medical Equipment, Orthotics and Prosthetics. To request a document in paper format, please contact Member Services at1-833-552-3876(TTY 711). Eligibility Requirements:The program is available to Carolina Complete Health members age 18 years or olderwith prediabetes, a Body Mass Index (BMI) of 25+ (Asian individual(s) with BMI of 23+) and have an A1c between 5.7% - 6.4. Welcome to Wellcare; Join our Network; Medicare Resources; Medicaid Resources . Member Handbook, Manuals, Policies, and Forms - Carolina Complete Health A trained Lifestyle Coach will teach a small group of members how healthy eating, exercise, and behavior changes can help lower their risk for diabetes and improve their overall health. PCS Provider Manual - North Carolina Medicaid Personal Care Services has recently published a new Medicaid Bulletin article: . An official website of the State of North Carolina An official website of NC How you know . NCTracks is the new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NC DHHS). U.S. Government rights to use, modify, reproduce, release . About; Administrative Offices; . Medicaid. 2022 Policies and Manuals Explore our provider manuals to find resources about Aetna policy guidelines that explain how to work with us. PREVENTIVE MEDICAL SERVICES. Here are links to the manuals, forms, and policies available to you. PCG is also contracted to conduct our online training component (NCGS 108C-9). News; Press Releases; Media Contacts; Events; Newsletter Articles; About. An official website of the State of North Carolina, Occupations regulated by North Carolina require licensure, Health care facilities in North Carolina must be licensed, Review updated inspection reports, facility rating and penalties, North Carolina Reproductive Health Services, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing, Data Dashboards, Action Plans/White Papers. State Government websites value user privacy. February 18, 2022. To receive reimbursement, the out-of-state provider must enroll as a North Carolina Medicaid provider in an abbreviated, expedited process called Out-of-State (OSS) Lite. December 2, 2022. AmeriHealth Caritas North Carolina Provider Manual Welcome. State Government websites value user privacy. Providers with questions about the NCTracks online enrollment application can contact the CSRA Call Center at 800-688-6696; 919-851-4014 (fax), or NCTracksprovider@nctracks.com. The federal COVID-19 Public Health Emergency (PHE) ended May 11, 2023. Durable Medical Equipment (DME) refers to the following categories of equipment and related supplies for use in a beneficiarys home: NC Medicaidhas designated Roche Diagnostics Corporation Diabetes Care as the preferred manufacturer for glucose meters, test strips, control solutions, lancets and lancing devices. Qualifying Medicaid Standard Plan members in 33 North Carolina counties may receive housing, transportation and food services through the Healthy Opportunities Pilots . Please see the Provider Manual and/or Quick Reference Guide (QRG) for additional information. NC DHHS: Medicaid - NC DHHS: North Carolina Department of Health and To learn more, view our full privacy policy. Provider Manuals and Guides - provider.healthybluenc.com Refer to the following links for coverage information and policy guidance. RECIPIENTS - Click on the Recipients tab above to enter the Recipient Portal. A customer has been granted retroactive eligibility, Medically necessary services were rendered and the provider's credentials, licensure, certifications, etc., were active and in good standing for the earliest effective date of service. Visit the Provider Playbook for fact sheets, training, webinars and other resources to help you transition to managed care. Provider Manuals and Forms - AmeriHealth Caritas North Carolina Join our network. members. Tests and evaluates the impact of providing select evidence-based, non-medical interventions related to housing, food, transportation and interpersonal safety and toxic stress to high-needs Medicaid enrollees. State Government websites value user privacy. State Government websites value user privacy. The NC Medicaid Ombudsman is a resource to help Medicaid beneficiaries learn more about NC Medicaid Managed Care, understand their rights and responsibilities, and receive referrals for other services that they may need. network must be screened and enrolled as a Medicaid provider by the North Carolina Department of Health and Human Services (NCDHHS) and shall be reenrolled every three years, except as 01-22. To learn more, view our full privacy policy. Previously Denied Billing Codes for NP, PA and Certified Nurse Midwives. NC DHHS: In-Home Aides - NC DHHS: North Carolina Department of Health Review theProvider Guide for Pregnant Members (PDF)for additional support and resources! 2022 Federal Poverty Level Changes (FPL), Cost of Living Adjustment (COLA) Disregard and Low Income Subsidy (LIS) Income Limits. Update to Manual Pricing Calculation for Prior Approval and Claims Processing Forms. to the Manual. North Carolina Seniors Farmers' Market Nutrition Program (SFMNP) Visit RelayNCfor information about TTY services. PDF Sis100 Instructions for The Sis Client Entry Form Dss-5027 Sis100.01 Providers who do not complete the recredentialing process on time will be suspended from Medicaid program participation. and together we can improve the lives of North Carolina's Medicaid members. Non-covered State . Secure websites use HTTPS certificates. Stay up to date with us. The Claims Payment Policy Disputes Department has created a new mailbox for provider issues related strictly to payment policy. MA-3435 COMMUNITY CARE OF NORTH CAROLINA (CCNC)/CAROLINA ACCESS (CA) MA-3500 CONFIDENTIALITY MA-3505 MEDICAID IDENTIFICATION CARD MA-3510 THIRD PARTY RECOVERY . COMMUNITY ALTERNATIVES PROGRAMS (CAP) CASE MANAGEMENT FOR ADULTS AND CHILDREN AT RISK OF ABUSE, NEGLECT, AND EXPLOITATION (AT-RISK CASE MANAGEMENT) CASE . For provider inquiries, concerns, complaints regarding health plansMedicaid.ProviderOmbudsman@dhhs.nc.govPhone: 866-304-7062. Emergency Response: Provider Reimbursement for North Carolina Medicaid Claims are processed in real time. NC Senate Bill 105 Session Law 2021-180 Section 9D.9(a) waived the $100 North Carolina Medicaid application fee for new provider enrollment and reverification applications effective from Jan. 9, 2022, through expiration on June 30, 2023. . To receive . The procedure code list below includes NP, PA and CNM taxonomies that now can be billed through NCTracks. 5 . A provider can also complete the NOP in the Secure Provider Portal under Assessments in the member's health record. For reimbursement of medical equipment and devices that are not available through an enrolled provider located within NC or in the 40-mile border area. . For Providers | Trillium Health Resources NC DHHS: Providers Eligibility Requirements:The program is available to Carolina Complete Health members age 18 years or older who have been diagnosed with high blood pressure. MA-2180 HEALTH COVERAGE FOR WORKERS WITH DISABILITIES. You will need Adobe Reader to open PDFs on this site. An official website of the State of North Carolina, North Carolina Reproductive Health Services, Mental Health, Developmental Disabilities, and Substance Abuse, Office Of Minority Health And Health Disparities, Services for the Deaf and the Hard of Hearing, Data Dashboards, Action Plans/White Papers. . An official website of the State of North Carolina, Program Specific Clinical Coverage Policies, Frequently Asked Questions and Answers - Medicaid Providers, 1L-2, Moderate (Conscious) Sedation, AKA Procedural Sedation and Analgesia (PSA), 13A, Cochlear and Auditory Brainstem Implant External Parts Replacement and Repair, 13B, Soft Band and Implantable Bone Conduction Hearing Aid External Parts Replacement and Repair, 8A, Enhanced Mental Health and Substance Abuse Services, 8A-1, Assertive Community Treatment (ACT) Program, 8A-2, Facility-Based Crisis Service for Children and Adolescents, 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers, 8D-1, Psychiatric Residential Treatment Facilities for Children under the Age of 21, 8E, Intermediate Care Facilities for Individuals with Intellectual Disabilities, 8F, Research-Based Behavioral Health Treatment (RB-BHT) For Autism Spectrum Disorder (ASD), 8I, Psychological Services in Health Departments and School-Based Health Centers Sponsored by Health Departments to the under-21 Population, 8J, Children's Developmental Service Agencies (CDSAs), 8L, Mental Health/Substance Abuse Targeted Case Management, 8N, NC Health Choice Intellectual and Developmental Disabilities Targeted Case Management, 8-O, Services for Individuals with Intellectual and Developmental Disabilities and Mental Health or Substance Abuse Co-Occurring Disorders, 1R-1, Phase II Outpatient Cardiac Rehabilitation Programs, 1R-4, Electrocardiography, Echocardiography, and Intravascular Ultrasound, 3B, PACE (Program of All-Inclusive Care for the Elderly), 3G-1, Private Duty Nursing for Beneficiaries Age 21 and Older, 3G-2, Private Duty Nursing for Beneficiaries Under 21 years of Age, 3K-1, Community Alternatives Program for Children (CAP/C), 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA), 3L, State Plan Personal Care Services (PCS), 1-I, Dietary Evaluation and Counseling and Medical Lactation Services, 2B-2, Geropsychiatric Units in Nursing Facilities, 1S-1, Genotyping and Phenotyping for HIV Drug Resistance Testing, 1S-5, Genetic Testing for Susceptibility to Breast and Ovarian Cancer (BRCA), 1S-7, Gene Expression Profiling for Breast Cancer, 1S-8, Drug Testing for Opioid Treatment and Controlled SubstanceMonitoring, 1M-4, Home Visit for Newborn Care and Assessment, 1M-5, Home Visit for Postnatal Assessment and Follow-up Care, 1M-6, Maternal Care Skilled Nurse Home Visit, 5A-1, Physical Rehabilitation Equipment and Supplies, 1E-2, Therapeutic and Non-therapeutic Abortions, Clinical Coverage Criteria and Prior Approval request forms, 9B, Hemophilia Specialty Pharmacy Program, 9D, Off Label Antipsychotic Safety Monitoring in Beneficiaries Through Age 17, 9E, Off Label Antipsychotic Safety Monitoring in Beneficiaries 18 and Older, Behavioral Health Clinical Edits Criteria - Adults, Behavioral Health ClinicalEdits Criteria - Pediatrics, Hematinics (Procrit, Epogen, Aranesp, Mircera, Retacrit), Migraine Therapy - Calcitonin Gene-Related Inhibitors, Neuromuscular Blocking Agents (Botox, Myobloc, Dysport, Xeomin), Mu-Opioid Receptor Antagonists, Peripherally-Acting (Relistor), Therapeutic Continuous Glucose Monitoring Systems (CGM) and Related Supplies, 1A-2, Preventive Medicine Annual Health Assessment, 1A-4, Cochlear and Auditory Brainstem Implants, 1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment, 1A-6, Invasive Electrical Bone Growth Stimulation, 1A-7, Neonatal and Pediatric Critical and Intensive Care Services, 1A-9, Blepharoplasty/Blepharoptosis (Eyelid Repair), 1A-11, Extracorporeal Shock Wave Lithotripsy, 1A-15, Surgery for Clinically Severe or Morbid Obesity, 1A-20, Sleep Studies and Polysomnography Services, 1A-21, Endovascular Repair of Aortic Aneurysm, 1A-23, Physician Fluoride Varnish Services, 1A-24, Diabetes Outpatient Self-Management Education, 1A-32, Tympanometry and Acoustic Reflex Testing, 1A-33, Vagus Nerve Stimulation for the Treatment of Seizures, 1A-36, Implantable Bone Conduction Hearing Aids (BAHA), 1A-39, Routine Patient Costs Furnished in Connection with Participation in Qualifying Clinical Trials, 1A-41- Office Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone, 1C-2, Medically Necessary Routine Foot Care, 1K-7, Prior Approval for Imaging Services, 1-O-1, Reconstructive and Cosmetic Surgery, 1-O-5, Rhinoplasty and/or Septorhinoplasty, 1D-1, Refugee Health Assessments Provided in Health Departments, 1D-2, Sexually Transmitted Disease Treatment Provided in Health Departments, 1D-3, Tuberculosis Control and Treatment Provided in Health Departments, 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, 11B-8, Small Bowel and Small Bowel/Liver and Multivisceral Transplants, 10D, Independent Practitioners Respiratory Therapy Services, 11A-1, Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia (ALL), 11A-2, Hematopoietic Stem-Cell Transplant for Acute Myeloid Leukemia, 11A-3, Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia, 11A-5, Allogeneic Hematopoietic Transplant for Genetic Diseases and Acquired Anemias, 11A-6, Hematopoietic Stem-Cell Transplantation in the Treatment of Germ Cell Tumors, 11A-7, Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma, 11A-8, Hematopoietic Stem-Cell Transplantation For Multiple Myeloma and Primary Amyloidosis, 11A-9, Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes & Myeloproliferative Neoplasms, 11A-10, Hematopoietic Stem-Cell Transplantation (HSCT) for Central Nervous System (CNS) Embryonal Tumors & Ependymoma, 11A-11, Hematopoietic Stem-Cell Transplant for Non-Hodgkins Lymphoma, 11A-14, Placental and Umbilical Cord Blood as a Source of Stem Cells, 11A-15, Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood, 11A-16, Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL), 12B, Human Immunodeficiency Virus (HIV) Case Management, 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, 6A, Routine Eye Exam and Visual Aids for Recipients Under Age 21, 6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older. To see DHHS Policies, Manuals and Forms, please go to:https://policies.ncdhhs.gov/, NC Department of Health and Human Services Stay up to date with us. 8A-2, Facility-Based Crisis Service for Children and Adolescents. If the re-credentialing application is not submitted, reminders will be sent at 50 days, 20 days, and 5 days prior to the provider re-credentialing due date. NC Medicaid Contact CenterPhone: 888-245-0179, Provider Ombudsman ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are required to use ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2015. 1 . For the reimbursement of services rendered toNC Medicaid or NCHC beneficiaries in response to emergencies or if travel back to NC would endanger the health of the eligible beneficiaries; For reimbursement of a prior-approved non-emergency service; or. Learn about available programs and services, if youre eligible and how to apply. During two Accessibility for All events, the state of North Carolina will honor the passage of this landmark civil rights law by highlighting how assistive technology helps the more . State Government websites value user privacy. The PCS Provider Manual lists provider requirements and PCS program information in North Carolina. Provider Manual. . . MENU. AMH Provider-Manual-2.4.3 FINAL (1).pdf. MA-2240 TRANSFER OF ASSETS. I. RESIDENCY REQUIREMENT . Billing Guidelines Billing guidelines and instructions are located in the dedicated Carolina Complete Health Billing Manual. Phone: 800-723-4337. North Carolina. Providers Manuals. PDF Provider and Billing Manual - Affordable Health Insurance in North Carolina Emergency Response Provider Enrollment Requirements | SCDHHS If a practitioner/provider already participates with Ambetter of North Carolina in the Medicaid or a Medicare product, the practitioner/provider will NOT be separately credentialed for the Ambetter product. UnitedHealthcare Community Plan of North Carolina Homepage Early notification of pregnancy allows the health plan to assist the beneficiary with prenatal care coordination of services. NCTracks AVRS Advanced Medical Home Provider Manual | NC Medicaid 09-23 . The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone.Phone: 800-723-4337, This page was last modified on 01/25/2023, An official website of the State of North Carolina, Rules and exceptions for providers billing beneficiaries, NCTracks claims processing and provider enrollment system. 2023 Policies and Manuals To receive Medicaid in North Carolina (NC), an applicant/beneficiary (a/b) must be a North Carolina resident and meet financial and non-financial requirements. For hard copies of this Provider Manual please contact the Provider Services department at 1-833-552-3876 or if you need further explanation on any topics discussed in the manual. PDF North Carolina Medicaid Quick Reference Guide - English PDF 2.93 MB . Claims adjudicated for providers who do not have valid EFT information on file will suspend for 45 days awaiting an EFT update, after which they will deny. NCTracks Contact Center . Review the Provider Guide for Pregnant Members (PDF) for additional support and resources! PDF 2023 Care Provider Manual State Government websites value user privacy. Medicaid and NC Health Choice providers can research their questions and submit inquires through: Frequently Asked Questions and Answers - Medicaid Providers. NC Medicaid or CSRA will communicate by email if missing or additional information is needed from providers. State Government websites value user privacy. 2001 Mail Service Center providers. Once counties conduct the financial determination and establish the patient monthly liability (PML), the PML will be shared with health plans and allow payments to proceed to nursing facilities. Assessing Eligibility for the North Carolina Medicaid Personal Care Services. Providing training and support to their providers; Providing Medicaid Waiver materials to help their providers strengthen their practice; NOTE - Taxonomy information can be found on the Provider User Guides and Training page, Currently Enrolled Provider (CEP) Registration, Provider Re-credentialing/Re-verification, New Medicare Card Project (formerly SSNRI), Medicaid Direct Tailored Care Management Provider Claims Billing Guidance, Medicaid Direct PHIP Tailored Care Management Billing Guide, Provider Claims and Billing Assistance Guide, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), EOB Code Crosswalk to HIPAA Standard Codes, Medicaid and NCHC Clinical Coverage Policies, NCTracks Benefit Plans Mapped to DHB Eligibility Coverage Codes, NCTracks Benefit Plans Not Mapped to DHB Eligibility Coverage Codes, LME MCO Manual for Encounter Data Submission, Prepaid Inpatient Health Plan Encounter Edit Manual, Instructions for Federal Sterilization Consent Form, Instructions for Filling Out a Hysterectomy Statement, NC Medicaid Non-Emergency Medical Transportation (NEMT) Provider/Broker Attestation Form, NCTracks Provider Refund Form Instructions, Out-of-State Durable Medical Equipment (DME) Provider Form, Reproductive Health Forms (Hysterectomy Statement, Sterilization Consent Form, etc. 8A-1, Assertive Community Treatment (ACT) Program. The following policies, manuals, guidelines, and forms are intended to assist providers in billing for services covered under one or more of the NC DHHS divisions supported by NCTracks. Celebrating the ADA's 33rd Anniversary Through a Focus on Assistive STATE AND FISCAL AGENT STAFF - Click on the Operations tab above to enter the Operations Portal and . February 28, 2022. . REVISED 05/30/2023 - CHANGE NO. The links below reference the latest PA forms for submission to NCTracks. To contract with the Community Plan of North Carolina - Medicaid please contact the NC Health Plan . The NC . Limit four gift cards per member. Certain nurse practitioner (NP), physicians assistant (PA) and certified nurse midwives (CNM) services have received denials due to incorrect billing codes since July 2013. MA-2230 FINANCIAL RESOURCES.
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