WellCare Medicare members are not affected by this change. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Copyright 2023 Wellcare Health Plans, Inc. Download the free version of Adobe Reader. Tampa, FL 33631-3372. 941w*)bF
iLK\c;nF mhk} Select your topic and plan and click "Chat Now!" to chat with a live agent! At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. You can file your appeal by calling or writing to us. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. Transition/continuity of care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Members must have Medicaid to enroll. To continue care with their current provider after the 90-day Transition of Care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. N .7$* P!70 *I;Rox3
] LS~. Written notice is not needed if your expedited appeal request is filed verbally. When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. hbbd``b`$= $ The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. This must be done within 120 days from the date of Notice of Appeal Resolution you received from us. A grievance is when you tell us about a concern you have with our plan. Q. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Where should I submit claims for WellCare Medicaid members? This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. From time to time, WellCare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. March 14-March 31, 2021, please send to WellCare. Our toll-free fax number is 1-877-297-3112. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. A. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Q. A. Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and Absolute Total Care? Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Can I continue to see my current WellCare members? More Information Coronavirus (COVID-19) Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. A. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. For dates of service on or after April 1, 2021: Absolute Total Care 2) Reconsideration or Claim disputes/Appeals. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. For the latest COVID-19 news, visit the CDC. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. Members will need to talk to their provider right away if they want to keep seeing him/her. Tampa, FL 33631-3384. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Always verify timely filing requirements with the third party payor. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Please see list of services that will require authorization during this time. From Date Institutional Statement Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. Member Sign-In. All Paper Claim Submissions can be mailed to: WellCare Health Plans Send your written appeal to: We must have your written consent before someone can file an appeal for you. Living Well Quality of Care Medicaid Managed Care Medicaid and CHIP Quality Resource Library Improvement Initiatives Performance Measurement Releases & Announcements Enrollment Strategies Continuous Eligibility Express Lane Eligibility Lawfully Residing Immigrant Children & Pregnant Women Presumptive Eligibility Home & Community Based Services You can file a grievance by calling or writing to us. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. The current transaction means that WellCare of South Carolina Medicaid members are transitioning to Absolute Total Care and will become Absolute Total Care members, effective April 1, 2021. Learn how you can help keep yourself and others healthy. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021. $8v + Yu @bAD`K@8m.`:DPeV @l If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Q. Hearings are used when you were denied a service or only part of the service was approved. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . (This includes your PCP or another provider.) Q. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. 1071 0 obj
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An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
If you are unable to view PDFs, please download Adobe Reader. The rules include what we must do when we get a grievance. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Claims Department Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. A provider can act for a member in hearings with the member's written permission in advance. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. Download the free version of Adobe Reader. Wellcare uses cookies. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Wellcare uses cookies. State Health Plan State Claims P.O. If you think you might have been exposed, contact a doctor immediately. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. DOS April 1, 2021 and after: Processed by Absolute Total Care. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. You and the person you choose to represent you must sign the AOR form. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. You must ask within 30 calendar days of getting our decision. 3) Coordination of Benefits. Q. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. ?-}++lz;.0U(_I]:3O'~3-~%-JM Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. The way your providers or others act or treat you. WellCare Medicare members are not affected by this change. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. You may do this in writing or in person. Farmington, MO 63640-3821. Finding a doctor is quick and easy. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. Wellcare uses cookies. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. You will need Adobe Reader to open PDFs on this site. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. On June 19, 2018, the Family and Social Services Administration's ("FSSA") Indiana Health Coverage Programs ("IHCP") released provider bulletin BT201829 regarding revising the timely filing limit for Medicaid fee-for-service claims. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Absolute Total Care will honor those authorizations. you have another option. 837 Institutional Encounter 5010v Guide How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Resources Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). We will give you information to help you get the most from your benefits and the services we provide. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40
b666q1(UtUJJ.i` (T/@E For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. P.O. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. The annual flu vaccine helps prevent the flu. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. A. Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. It will let you know we received your appeal. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. The materials located on our website are for dates of service prior to April 1, 2021. Our health insurance programs are committed to transforming the health of the community one individual at a time. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Box 8206 Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Q. A. Or you can have someone file it for you. You can file the grievance yourself. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Kasapulam ti tulong? WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. endstream
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Within five business days of getting your grievance, we will mail you a letter. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. A. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. 0
We are glad you joined our family! Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. and Human Services Wellcare uses cookies. Q. Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID 68069 for Emdeon/WebMD/Payerpath or 4272 for Relay Health/McKesson. Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. It was a smart move. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Box 31224 From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. You can ask in writing for a State Fair Hearing (hearing, for short). Federal Employee Program (FEP) Federal Employee Program P.O. No, Absolute Total Care will continue to operate under the Absolute Total Care name. Wellcare uses cookies. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. The state has also helped to set the rules for making a grievance. First Choice can accept claim submissions via paper or electronically (EDI). The provider needs to contact Absolute Total Care to arrange continuing care. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Section 1: General Information. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Additionally, WellCare will have a migration section on their provider page at
publishing FAQs. How do I bill a professional submission with services spanning before and after 04/01/2021? The hearing officer will decide whether our decision was right or wrong. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. To avoid rejections please split the services into two separate claim submissions. Claims Department z4M0(th`1Lf`M18c BIcJ[%4l JU2 _
s Provider can't require members to appoint them as a condition of getting services. You may request a State Fair Hearing at this address: South Carolina Department of Health To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. We expect this process to be seamless for our valued members and there will be no break in their coverage. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. A. Q. P.O. Welcome to Wellcare By Allwell, a Medicare Advantage plan. Learn more about how were supporting members and providers. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. Keep yourself informed about Coronavirus (COVID-19.) Please contact our Provider Services Call Center at 1-888-898-7969. You and the person you choose to represent you must sign the AOR statement. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. Columbia, SC 29202-8206. Instructions on how to submit a corrected or voided claim. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Ambetter Timely Filing Limit of : 1) Initial Claims. You can also have a video visit with a doctor using your phone or computer. Awagandakami WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. Explains how to receive, load and send 834 EDI files for member information. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. Q. Tampa, FL 33631-3372. We try to make filing claims with us as easy as possible. The Medicare portion of the agreement will continue to function in its entirety as applicable. 1096 0 obj
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Box 31384 A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. That's why we provide tools and resources to help. We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. Reimbursement Policies North Carolina PHP Billing Guidance for Local W Code. It will tell you we received your grievance. You will have a limited time to submit additional information for a fast appeal. For dates of service on or after 4/1/2021: Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID <68069> for Emdeon/WebMD/Payerpath or <4272> for Relay Health/McKesson. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. If at any time you need help filing one, call us. More Information Need help? Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Call us to get this form. A. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. It is called a "Notice of Adverse Benefit Determination" or "NABD." We expect this process to be seamless for our valued members, and there will be no break in their coverage. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. These materials are for informational purposes only. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! Welcome to WellCare of South Carolina! Will Absolute Total Care change its name to WellCare? A. Reconsideration or Claim Disputes/Appeals: the timely filing limits due to the provider being unaware of a beneficiary's coverage. In this section, we will explain how you can tell us about these concerns/grievances. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. Download the free version of Adobe Reader. You will get a letter from us when any of these actions occur. A. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. P.O. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. People of all ages can be infected. DOS prior to April 1, 2021: Processed by WellCare. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing.
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