Ensuring Compliance

MRIoA approaches ongoing compliance developments with innovation and flexibility, both in our processes and our products as we continue to stay ahead of legislative changes and new regulations.

Our Number One Priority

Compliant in all 50 States

Regulatory Compliance has never been as critical as it is in today's healthcare environment. The MRIoA Regulatory Compliance Program proactively tracks applicable state and federal laws and regulations and identifies and resolves issues to ensure compliance.

Tap the map twice to see details.

Hawaii

MRIoA's Hawaii Credentials

Utilization Review License
Not Required
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Hawaii IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

Maine

MRIoA's Maine Credentials

Utilization Review License
Yes- License #URF33791
IRO License
No
Worker's Compensation UR License
No
Medical Director Licensure
Not Required
Maine IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

New Hampshire

MRIoA's New Hampshire Credentials

Utilization Review License
Yes- License #MR067
IRO License
Yes- Certificate #1214-420-J: 5-d
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
New Hampshire IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
20 days from the date of receipt of any new or additional info from the covered person
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

Vermont

MRIoA's Vermont Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Vermont IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Massachusetts

MRIoA's Massachusetts Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
No
Medical Director Licensure
Not Required
Massachusetts IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Rhode Island

MRIoA's Rhode Island Credentials

Utilization Review License
Yes- Certificate #186
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Rhode Island IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Connecticut

MRIoA's Connecticut Credentials

Utilization Review License
Yes - Certificate #200001318
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
Connecticut IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

New York

MRIoA's New York Credentials

Utilization Review License
DFS: Yes; DOH: Yes
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
New York IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

New Jersey

MRIoA's New Jersey Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
New Jersey IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Pennsylvania

MRIoA's Pennsylvania Credentials

Utilization Review License
Yes
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Pennsylvania IRO
Type of Cases
Applies to all adverse determinations involving medical judgment and rescissions
Assignment of IRO
Assigned by health carrier
Standard TAT
45 days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Does not meet strict or similar standards. Follow FER process.

Delaware

MRIoA's Delaware Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Delaware IRO
Type of Cases
Applies to medical necessity or appropriateness of services
Assignment of IRO
Assigned by state
Standard TAT
45 calendar days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets similar standards

District Of Columbia

MRIoA's District Of Columbia Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
District Of Columbia IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Maryland

MRIoA's Maryland Credentials

Utilization Review License
Yes- Certificate # 148
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Maryland IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

West Virginia

MRIoA's West Virginia Credentials

Utilization Review License
Not Required
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
West Virginia IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by health carrier
Standard TAT
45 calendar days from receipt of the request
Expedited TAT
7 calendar days from receipt of request
PPACA Compliance
Does not meet strict or similar standards. Follow FER process.

Virginia

MRIoA's Virginia Credentials

Utilization Review License
Yes- Certificate # P-01-06 (R-11)
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
Virginia IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care or effectiveness and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

North Carolina

MRIoA's North Carolina Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
North Carolina IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

South Carolina

MRIoA's South Carolina Credentials

Utilization Review License
Yes- License #144231
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
South Carolina IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Georgia

MRIoA's Georgia Credentials

Utilization Review License
Yes- Certificate #00-PRA-099
IRO License
Yes- Certificate #C2-01
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Georgia IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
15 days from receipt of all info
Expedited TAT
72 hours from receipt of all info
PPACA Compliance
Does not meet strict or similar standards. Follow FER process.

Florida

MRIoA's Florida Credentials

Utilization Review License
Not Required
IRO License
Not Required
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Florida IRO
Type of Cases
Applies to all adverse determinations involving medical judgement and recissions
Assignment of IRO
Assigned by health carrier
Standard TAT
45 days after receipt of the request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Does not meet strict or similar standards. Follow FER process.

Alabama

MRIoA's Alabama Credentials

Utilization Review License
Yes
IRO License
Not Required
Worker's Compensation UR License
Yes - Certificate #11012
Medical Director Licensure
Not Required
Alabama IRO
Type of Cases
Applies to all adverse determinations involving medical judgment and rescissions.
Assignment of IRO
Assigned by health carrier
Standard TAT
45 days after receipt of the request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Does not meet strict or similar standards. Follow FER process.

Mississippi

MRIoA's Mississippi Credentials

Utilization Review License
Yes- License #R0054
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
Mississippi IRO
Type of Cases
Applies to medical necessity, experimental/investigational and rescissions and coverage issues
Assignment of IRO
Assigned by state
Standard TAT
40 days after receipt of the request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

Tennessee

MRIoA's Tennessee Credentials

Utilization Review License
Yes
IRO License
Yes
Worker's Compensation UR License
Yes
Medical Director Licensure
Not Required
Tennessee IRO
Type of Cases
Applies to all adverse determinations
Assignment of IRO
Assigned by health carrier
Standard TAT
40 days after receipt of the request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

Ohio

MRIoA's Ohio Credentials

Utilization Review License
Not Required
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Ohio IRO
Type of Cases
Applies to determinations involving medical judgment or decisions based on any medical information and contractual issues
Assignment of IRO
Assigned by state
Standard TAT
30 calendar days from date of IRO assignment
Expedited TAT
72 hours from date of IRO assignment
PPACA Compliance
Meets strict standards

Kentucky

MRIoA's Kentucky Credentials

Utilization Review License
Yes- Certificate # UR00910011
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Kentucky IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Indiana

MRIoA's Indiana Credentials

Utilization Review License
Yes- License # 31369
IRO License
Yes- License #712948
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Indiana IRO
Type of Cases
Applies to appropriateness, medical necessity, experimental/ investigational and rescissions
Assignment of IRO
Assigned by health carrier
Standard TAT
15 business days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets similar standards

Michigan

MRIoA's Michigan Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Michigan IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Illinois

MRIoA's Illinois Credentials

Utilization Review License
Yes
IRO License
Yes
Worker's Compensation UR License
Yes
Medical Director Licensure
Not Required
Illinois IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
5 business days from receipt of all info, or 45 days after notice of assignment of IRO, whichever is sooner
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Wisconsin

MRIoA's Wisconsin Credentials

Utilization Review License
Not Required
IRO License
Yes- Certificate #16381
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Wisconsin IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
30 business days from expiration of holding period and additional info time limits
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from expiration of holding period and additional info time limits
PPACA Compliance
Meets strict standards beginning January 1, 2015 Does not meet strict or similar standards. Follow FER process.

Louisiana

MRIoA's Louisiana Credentials

Utilization Review License
Yes
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Louisiana IRO
Type of Cases
Medical necessity, appropriateness, health care setting, level of care, effectiveness, experimental or investigational treatment, or rescission.
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards beginning January 1, 2015.

Arkansas

MRIoA's Arkansas Credentials

Utilization Review License
Yes-Certificate #0117
IRO License
Yes- Certificate # 1004
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Arkansas IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Missouri

MRIoA's Missouri Credentials

Utilization Review License
Yes- License #8026962
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
Missouri IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Iowa

MRIoA's Iowa Credentials

Utilization Review License
Yes
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Iowa IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by the state
Standard TAT
45 calendar days from receipt of all info
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets similar standards

Minnesota

MRIoA's Minnesota Credentials

Utilization Review License
Yes- License #40118774
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Minnesota IRO
Type of Cases
Applies to all adverse determinations involving medical judgment and rescissions
Assignment of IRO
Assigned by the state
Standard TAT
40 calendar days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets similar standards

Texas

MRIoA's Texas Credentials

Utilization Review License
Yes-License #5235
IRO License
No
Worker's Compensation UR License
Yes
Medical Director Licensure
Not Required
Texas IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Oklahoma

MRIoA's Oklahoma Credentials

Utilization Review License
Yes- License #861068
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
Oklahoma IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by health carrier
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Kansas

MRIoA's Kansas Credentials

Utilization Review License
Yes
IRO License
No
Worker's Compensation UR License
No
Medical Director Licensure
No
Kansas IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Nebraska

MRIoA's Nebraska Credentials

Utilization Review License
Yes- License #267933
IRO License
Yes-License #100185055
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Nebraska IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by health carrier
Standard TAT
45 days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

South Dakota

MRIoA's South Dakota Credentials

Utilization Review License
Yes- License #23471
IRO License
Yes- Certificate #23471
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
South Dakota IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

North Dakota

MRIoA's North Dakota Credentials

Utilization Review License
Yes
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Yes
North Dakota IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

New Mexico

MRIoA's New Mexico Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
New Mexico IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Colorado

MRIoA's Colorado Credentials

Utilization Review License
Not Required
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Colorado IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Montana

MRIoA's Montana Credentials

Utilization Review License
Yes
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Montana IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, or level of effectiveness or experimental or investigational
Assignment of IRO
Assigned by health carrier
Standard TAT
45 days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Alaska

MRIoA's Alaska Credentials

Utilization Review License
Not Required
IRO License
Not Required
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Alaska IRO
Type of Cases
Applies to medical necessity, experimental/investigational and coverage decisions involving medical judgment
Assignment of IRO
Assigned by health carrier
Standard TAT
21 working days from receipt of request
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Does not meet strict or similar standards. Follow FER process.

Arizona

MRIoA's Arizona Credentials

Utilization Review License
Yes
IRO License
Yes - Contract #ADSPO17-00006995
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Arizona IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care, effectiveness and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of all info
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

Nevada

MRIoA's Nevada Credentials

Utilization Review License
Yes- License # 16471
IRO License
Yes- License #18212
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Nevada IRO
Type of Cases
Applies to all adverse determinations
Assignment of IRO
Assigned by state
Standard TAT
15 days from receipt of all info
Expedited TAT
48 hours from receipt of request
PPACA Compliance
Meets strict standards

Idaho

MRIoA's Idaho Credentials

Utilization Review License
Not Required
IRO License
Yes- License # 354290
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Idaho IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of all info
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

California

MRIoA's California Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required for MRIoA's scope of services
Medical Director Licensure
Not Required
California IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Oregon

MRIoA's Oregon Credentials

Utilization Review License
Not Required
IRO License
No
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Oregon IRO
Type of Cases
Not Available
Assignment of IRO
Not Available
Standard TAT
Not Available
Expedited TAT
Not Available
PPACA Compliance
Not Available

Utah

MRIoA's Utah Credentials

Utilization Review License
Not Required
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Utah IRO
Type of Cases
Applies to medical necessity, appropriateness, health care setting, level of care or effectiveness and rescissions
Assignment of IRO
Assigned by state
Standard TAT
45 calendar days after receipt of request
Expedited TAT
72 hours after receipt of request
PPACA Compliance
Meets strict standards

Washington

MRIoA's Washington Credentials

Utilization Review License
Not Required
IRO License
Yes - Certificate #2001-06-A
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Washington IRO
Type of Cases
Applies to medical necessity, experimental/investigational and application of other health plan provisions.
Assignment of IRO
Assigned by health carrier
Standard TAT
15 calendar days from receipt of all info or 20 days from receipt of request, whichever is earlier
Expedited TAT
72 hours from receipt of all info or 8 days from receipt of request, whichever is earlier
PPACA Compliance
Meets strict standards

Wyoming

MRIoA's Wyoming Credentials

Utilization Review License
Not Required
IRO License
Yes
Worker's Compensation UR License
Not Required
Medical Director Licensure
Not Required
Wyoming IRO
Type of Cases
Applies to medical necessity and experimental/investigational
Assignment of IRO
Assigned by state
Standard TAT
45 days from receipt of all info
Expedited TAT
72 hours from receipt of request
PPACA Compliance
Meets strict standards

MRIoA's organization-wide compliance program includes:

State Licensures

  • Corporate: MRIoA is licensed as an LLC
  • Utilization review: MRIoA is licensed in all states where required
  • IRO: MRIoA is licensed in all states where required

Training

  • HIPAA
  • Code of Conduct
  • Confidentiality
  • Security
  • Conflict of Interest
  • URAC
  • Fraud, Waste and Abuse

Corporate Policy and Procedures

  • Comprehensive manual translating external standards into organizational documents
  • Reviewed and updated at least annually

Oversight

  • Monitoring and auditing of internal operations
  • Client Oversight audits

Medical Director licensures

  • Facilitates state licensures as required

Legal Affairs

  • Oversight of legal concerns (record requests, release of information, reviewer deposition, etc.)
  • Coordination with Medical Director and/or legal counsel

Accreditations, Certifications and Memberships

  • URAC* Accreditations since 2001
  • NCQA** Accreditation since 2006
  • HITRUST*** Certification since December 2016
  • NAIRO**** membership

*URAC is a non-profit independent accrediting agency that is well-known as a leader in promoting health care quality. Organizations that obtain accreditation demonstrate a commitment to quality and excellence with consistent compliance with best practices.

**NCQA is a non-profit organization dedicated to improving health care quality. The NCQA seal is a widely recognized symbol of quality.

***HITRUST (Health Information Trust Alliance) has developed the HITRUST CSF, a certifiable framework that provides organizations with the needed structure, detail and clarity relating to information security tailored to the healthcare industry. HITRUST certification signifies commitment to ongoing IT security.

****NAIRO (National Association of Independent Review Organizations) is a national trade association comprised of URAC accredited IROs whose primary mission is to protect the integrity of the independent review process.

Compliant in your State.

MRIoA maintains all industry accreditations and certifications in order to remain qualified in all the requirements involved in the medical review process.

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