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, 2015Does 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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