Electronic Claims & Office Ally Clearinghouse. reported in 24i, enter the 10-digit Provider . Yes, if you want to become a Medicare provider. To do this: Navigate to Settings > My Profile > Clinical. Per the California Official Medical Fee Schedule (OMFS) the reimbursement amounts for treatment can differ based on the providers Taxonomy Codes. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). The California Billing and Payment Guide issued by the Division of Workers Comp (DWC) requires providers to complete the CMS-1500 Form with the taxonomy code of the rendering provider when the rendering provider is a health care provider. Please compare the information submitted to the, Taxonomy does not exist for Rendering Provider. NPI# of the referring provider in the Charge Entry/Charge Master. Both the billing provider and the attending/rendering provider should include their own taxonomy codes on the claim. 33.a. Kaiser Permanente also requires that all CMS-1450 claims submitted are reported using the specific code sets as adopted by HIPAA. 11.a. %PDF-1.5 . 10.a., 10.b., 10.c. If you are a health, Read More How do I add a taxonomy code to my NPI?Continue, What is Taxonomy? How Do I Add A Taxonomy Code To My Claim Form? endstream endobj startxref . Select Provider Taxonomy from the Qualifier (17a) drop-down menu. This code will be required when applying for a National Provider Identifier, also known as an NPI. Enter the taxonomy code found in the NPPES NPI Registry. technologists or . 11 GROUP # of destination payer. The taxonomy code includes 10 alphanumeric characters. Claims Denied - Taxonomy Codes Missing, Incorrect, Or Inactive. endobj 1. 10d field under Others tab in Charge Entry/Charge Master screen. Attending Provider Taxonomy Code. Social Security Number (The social security number may not be used for Medicare.) 25 Display the FEDERAL TAX ID or SSN according to rules below. The following PHP denial/rejection codes may indicate claims have missing/invalid taxonomy codes: Attending not enrolled in Medicaid Program*, Billing Prov not enrolled in Medicaid Program*, Rendering Prov not enrolled in Medicaid Program*, ACK/REJECT INVAL INFO Payer Assigned Claim Control Number INVALID PAYER CLAIM CONTROL NUMBER SUBMITTED BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED ACK/REJECT MISS INFO Entitys specialty/taxonomy code. Taxonomy may be needed to establish a one-to-one NPI/LPI match if the provider has multiple locations. 4. The current version of the instructions for the 02/12 1500 Claim Form was released in July 2022. CMS 1500 (02/12) CLAIM FORM INSTRUCTIONS . and more. 3. Type the taxonomy code in the Facility ID (32b) text box. Location Number (This qualifier is used for Supervising Provider only.) The Healthcare Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment, specifically within the ASC X12N Healthcare transactions. BILLING OR RENDERING PROVIDER TAXONOMY CODE IS REQUIRED ACK/REJECT MISS INFOR Entitys specialty/taxonomy code. Electronic claims are processed an average of 14 days faster than paper claims. Select the referring doctor from the Select Referring Dr. drop-down menu. 3) If Separate Account in LE is NO, it will show the Primary Legal Entity Name & Address. Taxonomy codes must be included when submitting claims to prepaid health plans This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse. Shows the CHARGE amount for each CPTs as entered in the Charge Entry/Charge Master. 2418 0 obj <>/Filter/FlateDecode/ID[<9E8B232DA96B9D8DE948086024A74B78><9DEACAF672D09D4C9EA9E46BA12878FD>]/Index[2402 32]/Info 2401 0 R/Length 80/Prev 84947/Root 2403 0 R/Size 2434/Type/XRef/W[1 2 1]>>stream EMPLOYER name of the other payer insured person in Insurance Information screen under Patient Master. All our content are education purpose only. Taxonomy Code Requirement effective March 1, 2017 Updated February 9, 2017 . If you want a taxonomy code lookup then it is easy to find them. 3) If Separate Account in LE is NO, it will show the value from Primary Legal Entity. Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, Medicare revalidation process how often provide need to do FAQ, Step by step Guide Medicare participation program. 20 YES if OUTSIDE LAB option is selected and NO if not, also display the LAB CHARGES value from Lab tab in Charge Entry/Charge Master. A Type 2 NPI is an entity/organization NPI. You must log in or register to reply here. 24.c. Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. View the complete data set on data.cms.gov, where you can select various download formats to view the entire list. https:// Clearinghouses may be updating taxonomy information submitted by providers, so it is important that providers work with their clearinghouse to ensure valid taxonomy data is submitted to the PHPs on their claims. You are using an out of date browser. The Health Care Provider Taxonomy code is a ten-character alphanumeric code that is unique. Taxonomy codes will be required when submitting professional claims for all HAP and HAP Empowered business lines beginning January 1, 2020. For a better experience, please enable JavaScript in your browser before proceeding. 16 Display the DATE PATIENT UNABLE TO WORK FROM & TO from Others tab in Charge Entry/Charge Master. <> As cited earlier, the Taxonomy codes are unique 10-character long . 261QC0050X Critical Access Hospital. 682. 9.b. Providers must supply a valid NUCC taxonomy code when they apply for a National Provider Identifier (NPI). Taxonomy Code Example: 282N00000X . PATIENT ADDRESS, CITY, STATE, ZIP CODE & HOME PHONE from Patient Master. Insured person DOB and SEX of other payer in Insurance Information screen under Patient Master. Display the NDC code Details for J codes on the top colored area above the CPT code. For additional assistance, please follow up with the PHP with which your agency contracts. Professional claims. 33.b. In place of TPIs, providers will need to submit their NPI/API, taxonomy code, benefit code (if applicable), and complete address with city, state, and ZIP+4 code. 17 Name of REFERRING PROVIDER from Charge Entry/Charge Master. Insurance Claims & Payer Specific Requirements. When billing with a Type 2 NPI the entity's billing taxonomy code is required. Yes, if you want to become a Medicare provider. Include if attending provider differs from 2000A PRV01, 02, 03. Taxonomy may be needed to establish a one-to-one NPI/LPI match if the provider has multiple locations. When billing with a Type 1 NPI the individual's associated servicing taxonomy code. Follow the steps described below:-. Field 57: Include the appropriate taxonomy code for all lines of business. the CMS-1500 (08/05) or in the Rendering Provider ID field on the 837P electronic claim submission. APPROVED OMB-093B-1197 FORM CMS-1500 (06-15) OMB No. a) If Primary LE organization type is SOLO, it will show the NPI# of Rendering Provider. When Using the CMS-1500 Form When completing professional claims form (CMS-1500), please note the following: Field 24J (Rendering Provider ID #): This field is mandatory and should include the appropriate taxonomy code* for the provider rendering care. 11.c. Taxonomy code is constructed of 10 digits- numeric and alpha: (see example 1), Tips: If a clearinghouse does not submit a taxonomy or if the taxonomy is incorrect, these errors may increase the providers claim denials with the PHPs they submit claims to. number or CPT codes will delay payment or may result in rejection of the claim because of incomplete information. S Susannah Guest Messages 12 Best answers 0 Oct 17, 2014 #3 Yes, thanks a lot. Now the dust has settled, learn about the greatest impacts as a result of the CMS 2023 Final Rule. 2. & ||AO=G]?Q t3/w 4pFsZN.m1F]jh;x6>nsI*nPhu;uL[JiukXw*vEs\)RVAJR(A\GclcX.prJV|PN6Z|rS']6f&h[a6sv},Y2VE{osDi 7;G~>btU:Gtivik-'&iAk/h"3Z July 1, 2022. . Please compare the information submitted to the information registered with the state of North Carolina. The NUCC has developed a 1500 Reference Instruction Manual detailing how to complete the claim form. Shows the UNITS against each CPT entered in Charge Entry/Charge Master. This code list is a National Uniform Claim Committee (NUCC) property. January 2023 Taxonomy Code Set Updates Released. Below are three scenarios with Billing Requirements for each scenario. For a specific payer, please see: Box 33: Insurance Specific Billing Provider. If all the 3 are entered it will take ONSET OF CURRENT ILLNESS. Provider Taxonomy (The qualifier in the 5010A1 for Provider Taxonomy is PXC, but ZZ will remain the qualifier for the 1500 Claim Form.) PAYER TYPE of the destination payer. Name of the INSURED PERSON of the destination payer in Insurance Information screen under Patient Master. This setting can be managed in your global insurance company settings > HCFA 1500 tab. Taxonomy codes on electronic claim submissions with the ASC X12N 837I format are placed in below-listed data elements in respective Segment and Loop. A taxonomy code is a unique 10-character code that designates your classification and specialization. Here's how you know PIN and GROUP numbers have been eliminated from the CMS-1500 claim form. the NPI and taxonomy code in 24J. FIELD NUMBE R FIELD NAME INSTRUCTIONS 1 a . To become a Medicare provider and file Medicare claims, you must first enroll in the Medicare program. Once you click on search you will find your taxonomy number listed on the website. Other physician Taxonomy codes, including pediatric codes, may also be used. identification and/or taxonomy numbers are either missing or do not match the records on file. Patient has WC and Medicare insurance? A lock icon or https:// means youve safely connected to the official website. For billing purposes, the taxonomy code is entered into Field 24J Grey on the CMS-1500 form. Note: You may select more than one code or code description when applying for an NPI, but you must indicate one of them as the primary code. Patient INSURED # of the destination payer in the Insurance Information screen under Patient Master. NOT REQUIRED . 24.h. 12 & 13 are on file and enter the SIGNATURE DATE under Authorization Information section in Other Attributes page in Patient Master. Click Save Information. As a provider, do I need to know my taxonomy code? Required when applicable and for any waiver-related services. Medicare-covered vaccines are exempt from the HIPAA electronic billing requirement. This is a reminder to providers that taxonomy codes must be included when submitting claims to prepaid health plans (PHPs), whether the claim comes from the individual provider or through a clearinghouse. You won't have enough room to enter the full code if you 24.e. WebThe following are the most common reasons HCFA/CMS-1500 and UB/CMS-1450 paper claims for Veteran care are rejected: Requires the 17 alpha-numeric internal control number (ICN) [format: 10 digits + "V" + 6 digits] or 9-digit social security number (SSN) with no special . Taxonomy codes are classified into three levels: provider type (Level I), classification (Level II), and area of specialization (Level III). You must also check to the indicated below: * This requirement is normally payer specific and you should verify with individual payers as to the exact requirements prior to customizing these settings. b) If Primary LE organization type is NOT SOLO and, 1) If Separate Account in LE is YES and organization type is NOT SOLO, it will show the value from Legal Entity. [On the bottom non-colored area]. To learn more, view our full privacy policy. 30 Displays TOTAL BALANCE AMOUNT for this claim, 31 Displays RENDERING PROVIDER NAME, SIGNATURE ON FILE & CLAIM DATE. This will be YES if there is multiple payers for the patient in the Patient Master, and NO if there are no other payers for the patient. 337 0 obj <>stream 2023 FreePT - Physical Therapy EMR & Billing Software. 261QC1800X Corporate Health. If no rendering provider is placed in Box 31, then the Taxonomy Code should be placed . Gavin. 0 As such, all providers with NPIs will have self-identified with at least one provider taxonomy code. This page is for people who would like to get information about 101Y00000X Taxonomy code. You must log in or register to reply here. :[p0k,vbE1s"E/jvI,81x7~'qe,IA7A{`8& a/t6vLf )Cvt53|Dc]> KK*f/~;e=X ~\.Nl$K>J?$. Insured person DOB and SEX of destination payer. 315 0 obj <>/Filter/FlateDecode/ID[<86D185DC4EF304468483B748B0A1B472><30AE4BDABCD807458534D2A6627E5003>]/Index[277 61]/Info 276 0 R/Length 158/Prev 142042/Root 278 0 R/Size 338/Type/XRef/W[1 3 1]>>stream Display Y if FAMILY PLAN check box is selected under Others tab in Charge Entry. Box 17a, 19, 24i, 32b, 33b - Identifier Qualifiers. Displays the NPI# of the selected Service Location in the claim. adjudication. August 20, 2022 National Uniform Claim Committee (NUCC) Instructions: CMS-1500 (HCFA) To make things easier for you, DaisyBill created a table of National Uniform Claim Committee (NUCC) requirements. View the complete data set on data.cms.gov, where you can select various download formats to view the entire list. Hands down the best way to quickly determine up-to-date reimbursements and past dates of service. ZZ and PXC are the qualifiers that apply to the provider taxonomy code. Sign up to get the latest information about your choice of CMS topics. Usage: This code requires use of an Entity Code, ACK/REJECT MISS INFO Entitys specialty/taxonomy code. 12, 13 Select the option Signed Signature Auth. Display the NPI# according to the rules below. Who Needs Taxonomy Code? A providers taxonomy code can easily be found on the. 24j. . The code set is updated twice a year, with the updates being effective April 1 and October 1 of each year. The Healthcare Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment, specifically within the ASC X12N Healthcare transactions. On electronic claim submissions using the ASC X12N 837P and 837I format, taxonomy codes are placed in segment PRV03 and loop 2000A for the billing stage, and segment PRV03 and loop 2420A for the rendering level. CPT 91311, 0111A, 0112A Covid Vaccine for children, 5 Important points to improve claim submission success rate. Medicaid provider number (1D for CMS 1500 and G2 for UB04) or a taxonomy code (ZZ for CMS 1500 and B3 for UB04). State Government websites value user privacy. A taxonomy code describes the Provider or Organization's type, classification, and area of specialization. It is a one-of-a-kind 10-character code that denotes your classification and specialization. 21 Display first 4 DIAGNOSIS from the Charge Entry/Charge Master screen. 9.d. x[[~70OUr93z/NMxkE|gHCj(%E[@Jg?\]^-CC;Hv$f/.n4J\Vb:UUMgt.>].m,VY7]RHi;_|/"?cqO9 ?|z5ZIdo]I`o/_R nPIA"4~JAc;5DEtfMB+]pu&':xDV:xVFMt>r(sm/4q-u39wyD*w]^)~no>_k%#f!>{. This may not necessarily be the supervising provider. The taxonomy code 33 Display the details according to the rules below. endstream endobj 2403 0 obj <>/Metadata 38 0 R/Outlines 42 0 R/PageLabels 2398 0 R/Pages 2400 0 R/PieceInfo<>>>/StructTreeRoot 57 0 R/Type/Catalog>> endobj 2404 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Type/Page>> endobj 2405 0 obj <>stream Taxonomy codes should be submitted on claim forms as follows: ADA 2019 claim form Box 56a should contain the taxonomy code CMS-1500 claim form Rendering Provider Box 24i should contain the qualifier ZZ Box 24j should contain the taxonomy code Billing Provider Box 33b should contain the qualifier along with the taxonomy code There are two ways to submit claims to the Montana Healthcare Programs: Electronic and paper. 27 Select Yes/No of ACCEPT ASSIGNMENT under Authorization Information within Other Attributes page in Patient Master. The anesthesiology codes cannot be used to derive COS 030. And to get an NPI, your application will need to include the taxonomy code that reflects your classification and specialization. 3 0 obj Box 24I (shaded) must include a PXC or ZZ qualifier code for each line that is billed. Insured person information like ADDRESS, CITY, STATE, ZIP CODE & PHONE of destination payer in Insurance Information screen under Patient Master. 3 Taxonomy number: Code identifying a provider type and specialty OVERVIEW OF CLAIM FORM CHANGES Pending NPI implementation, continue to bill using your Medicaid Provider Number. 6. *PHP may be updating their denial/rejection code description. Enter appropriate ICD diagnosis codes horizontally in alpha order, Taxonomy Code in the shaded area. <>>> 28 . Where does the NPI belong on the CMS-1500? HCFA Box 24j You must select the Qualifier for Taxonomy and enter the code: 9.c. Each taxonomy code is a unique ten . In Application: By default, the system uses the information found under Admin > Member Info to populate Box 33b. Taxonomy codes are assigned to both individual and organizational providers. @i;pU- }@pHK00Ui00zMb0 ] 3 % http://www.wpc-edi.com/products/codelists/alertservice. 24.b. The CMS-1450 (UB-04) form is the industry standard for submitting institutional claims for inpatient and outpatient services. The lower portion of the CMS 1500 claim form ( item numbers 14-33 ) : Qualifiers are to be included on both paper and electronic claims for proper submission of claims Shows CPT codes & MODIFIERS entered in the Charge Entry/Charge Master. CMS has developed a taxonomy code crosswalk that connects the types of providers and suppliers who are eligible to apply for Medicare enrollment with the appropriate Healthcare Provider Taxonomy Codes. Name of OTHER PAYER. 261QD0000X Dental. You will use this code when applying for a National Provider Identifier, commonly referred to as an NPI. Enter the . An official website of the United States government. This guide will provide basic information to further instruct and educate all providers in assistance with taxonomy submittals. b) If Primary LE organization type is NOT SOLO and, 1) If Separate Account in LE is YES and organization type is NOT SOLO, it will show the Legal Entity Name & Address. 1.a. The Structure Of Taxonomy Codes. The top shaded portion is the location for the reporting supplemental information. 2) If Separate Account in LE is YES and organization type is SOLO, it will show the Rendering Provider Name & Address. An official website of the United States government The information may also be given to other providers of services, carriers, intermediaries, medical review boards, health plans, and other . . 81b with B3 qualifier. PATIENT NAME from Patient Master. 2) If Separate Account in LE is YES and organization type is SOLO, it will show the NPI# of Rendering Provider. 24.a. You can apply for an NPI at: www.cms.hhs.gov . endstream endobj 278 0 obj <. hbbd``b`z"Dc,$aqDtLKWH[80W-L,F?? A taxonomy code is a unique 10-character code that designates your classification and specialization. Required when applicable and for any waiver-related services. This list incorporated all types of providers associated with health care in various ways, e.g. Display value in RESERVED FOR LOCAL USE. ?]wo~?/93~x@s?J GW/-o}K3.TlAzu/^:}WW7_c`>Aq?>?=7.O{j-9=iWW/ern7/^wnvm)xssq)5 Display Y if EMERGENCY check box is selected under Others tab in Charge Entry. Their work resulted in a single taxonomy code set that both CMS and members of X12N found meaningful, easy to use, and functional for electronic transactions. Displays 2 character SECONDARY ID TYPE Qualifier & SECONDARY ID for the rendering provider against the billed insurance entered in Setup Insurance page under Provider Master. It complies with the National Standardized Billing Standards and is required for the accurate and timely claim processing. All the articles are getting from various resources. endstream endobj startxref Please reach out and we would do the investigation and remove the article. Claim processing only accepts a set number of alphabet characters or digits for your code. Phone support is limited to DC Pro and DC Platinum clients. Waiver providers billing atypical services with their NPI must use the taxonomy code 174400000X to identify it as a waiver service. For Medicare, Condition Code DR is reported only in the institutional claim (electronic 837I . These codes define the health care service provider type, classification, and area of specialization. 32.a. 2000A PRV01, 02, 03. This notification is an update to a previous communication regarding taxonomy code requirements for the CMS-1500 form and UB04. How to Setup Taxonomy Codes in Medisoft for Paper CMS-1500 Form - YouTube Gavin demonstrates how to setup the taxonomy code so it will print on a CMS-1500 claim form. This code is used to denote that the provider has an NPI . Patient INSURED # of the destination payer in the Insurance Information screen under Patient Master. Nearly two months after NC Medicaid Managed Care launch, PHPs continue to see the billing issue of professional and institutional EDI claims (ASC X12 837-P and ASC X12 837-I) with missing or invalid (non-taxonomy values or non-enrolled taxonomy codes) billing provider, rendering provider, and/or attending provider taxonomy codes. Taxonomy We bill kentucky medicaid and we must have our provider taxonomy in 24j above the NIP and zz in 24 I, example zz 107Q00000X with the same thing in 33 b. Taxonomy codes must be included when submitting claims to prepaid health plans. If you find anything not as per policy. Both provider identifiers and provider taxonomy 33b Situational If billing with the provider's NPI in field 33a, entering a taxonomy code is recommended. Taxonomy does not exist for Rendering Provider. It is not intended to allow the billing of 12 lines of . INSURED'S ID NUMBER . Providers may submit multiple rendering provider NPI and taxonomy at the line level on the CMS 1500 form, but rendering provider NPI and taxonomy can only be submitted at the claim level on the 837. 24.g. A Type 1 NPI is an NPI for a person. CODE field under Encounter tab within Charge Master. dD LkH `Y']& l9? Scenario One: Rendering NPI is different than the Billing NPI CMS 1500 Form Required Data . 1 0 obj Field 24I (ID Qualifier): Enter ZZ. To default to COS 030, HFS will use current default logic. taxonomy code if the NPI is entered in locator 33a open line. An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified. Heres how you know. "ZZ" for a paper CMS-1500 form in block 33b "PXC" for 5010A1 electronic submissions in loops 2000A, segment PRV03 Do not include spaces or hyphens in your taxonomy codes. or Claim Form for both Block Specialist. rendering/performing the service in the . This table reflects Healthcare Provider Taxonomy Codes (HPTC) effective July 1, 2004. A taxonomy code is a one-of-a-kind 10-character code that denotes your classification and specialization. PR0029 V1.5 01/24/2018 . Insured person EMPLOYER name of destination payer. Note: Applications for NPIs are processed through the National Plan & Provider Enumeration System, or NPPES. 11.b. To avoid any claims processing errors, providers should complete their claims with the same information that was included on the prior authorization request. CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK . 5. 10-digit NPI number of the individual . Usage: This code requires use of an Entity Code. Pro-Tip: Remember that the taxonomy code must be for the rendering provider, meaning the provider who actually performed the services. You can decide how often to receive updates. When applicable, a rendering/attending taxonomy code should also be submitted and should be valid, based on the service rendered and the rendering/attending provider location. 1.a. If you need help identifying your taxonomy code, or have other questions about the enrollment process, please contact us. hk\J6 [qXu0: M6)Y19H~B}v!Q;vY!am.J!|S,WW3btbWb5jfiE7?z+U/~7n_P}tlUrQeh@o7|}\xk}PW/UnOOwaoq'wWwo/? means youve safely connected to the .gov website. ZZ and PXC are the qualifiers that apply to the provider taxonomy code. A taxonomy code describes the Provider or Organizations type, classification, and area of specialization. Enter the qualifier "ZZ" followed by the 10-digit taxonomy code. WPC Health Care Provider Taxonomy Code Set, Webinar: California Workers Compensation: Master the Original Bill. 3) If Separate Account in LE is NO, it will show the NPI# of Primary Legal Entity. To give you a much clearer idea, let us first talk about the general structure that all the Taxonomy codes follow. 2433 0 obj <>stream How can I get an NPI? Medicare COB : 003 Optical Services . Providers must enter this taxonomy code in both the billing and the servicing taxonomy fields on the CMS-1500 (HCFA) claim form. 2) If Separate Account in LE is YES and organization type is SOLO, it will show the value from Rendering Provider. Below are simple instructions to determine the correct taxonomy code. If you have a Payer requirement to display a Taxonomy code on your HCFA claims form, this will normally display in either HCFA Box 24j or Box 33b. 3. A taxonomy code is a one-of-a-kind 10-character code that denotes your classification and specialization. .gov <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 12 0 R 20 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Each year the Centers for Medicare and Medicaid Services (CMS) rolls out the proverbial carpet and ushers in new rules on regulatory compliance, coding and reimbursement. unshaded area. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level.
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