You will likely need to gather all relevant documentation, including financial statements, proof of a commercial activity license, a business plan, and more. upfront and collect those fees today so we can get started. Moreover, the Tennessee exemption is somewhat broader than the third exemption under the Model Law, in that Tennessee also exempts an insurance company "acting as an insurer with respect to a policy lawfully issued and delivered by it in and pursuant to the laws of a state in which the insurer was authorized to conduct an insurance business. The role of third-party administrators is growing. 304.9-051 to 304.9-052; 304.9-371 to 304.9-377 (1986). Visit the Legislature's Website JUDICIAL The judicial branch includes the California Supreme Court and all the lower courts in the state, and it interprets and applies laws at state and local levels. Stat. Code Ann. How do I file? If you are concerned about managing the business registration process on your own, you can seek guidance from the business licensing experts at Harbor Compliance. In some instances, the third-party administrator can choose the defense counsel for a claim theyre managing. 58-56-2 to 58-56-66 (1991/2009); 11 N.C. Admin. We provide claims administration and other essential services to organizations of all types in both the private and public sectors. endstream endobj startxref While third-party administrator businesses are often called TPAs, they are also sometimes referred to as administrative services only (ASO) entities. Iowa Code 510.11 to 510.23 (1989/1996); Iowa Admin. we provide special support In response to calls for greater transparency in the prescription drug industry, 2019 continued a nationwide trend of increased state licensing and regulation of pharmacy benefit managers (PBMs). *Please note that ACS does NOT accept applications, payments, or other documents on a walk-in basis. Third Party Administrator bonds are required by The City of Norfolk, Department of Public Works to comply with the state, city, county, or federal government licensing requirements. In order to apply for and receive a TPA license, the Department requires a non-exempt applicant to have a valid contract with a life or health insurance company holding a Tennessee certificate of authority. WebThe Model Law defines an "administrator" or "third party administrator" as "a person who directly or California . Nev. Rev. Portable Electronics Limited Line License Raleigh NC 27699-1201, Contact NCDOIEmployee DirectoryCareers at NCDOICalendar, An official website of the State of North Carolina, Third Party Administrator (TPA) Licensing and Registration, Continuing Care Retirement Communities (CCRC), Individual Self-Insured Workers' Compensation Licensing, Insurance Company and County Farm Mutual Appointments and Terminations, Nonadmitted Domestic Surplus Lines Insurers Licensing, Professional Employer Organizations (PEOs). Frequently Asked Questions (FAQs) on List of Approved Have no current actions against their California CDL that would disqualify them to act as an examiner. 9. R. 836-075-0000 to 836-075-0070 (1992/2005). Third party administrator, also referred to as administrator, is a person who collects charges or premiums from, or who, for consideration, adjusts or settles claims of residents of the state in connection with insurance coverage, annuities, or service insurance coverage, except: A union on behalf of its members; endstream endobj startxref While most third-party administrators are businesses, independent individuals with the proper TPA certifications can work as independent contractors. endstream endobj 2506 0 obj <>stream Third Party Administrator - An organization that manages group insurance policies and works with the employer and insurance carrier to process claims, handle loss control, and provide risk management and consulting services. We offer a full spectrum of claims administration services, as well as field and appraisal expertise to our clients. The intent was for the statute to reach the nonadmitted carrier who was acting as an administrator, but as drafted the exemption would have excluded those carriers from the scope of the statute. National Association of Insurance Companies (NAIC)A standard setting and regulatory support organization that is governed by state insurance regulators. Ins. W. Va. Code 33-46-1 to 33-46-20 (2003). Title 8, Chapter 8, Subchapter 2, Article 12, Sections 15450-15463 provide information on the basic rules that govern claims administration. 44-5801 to 44-5816 (1992/2003). 376.1075 to 376.1095 (1993/1999); Mo. Harbor Compliance does not provide tax, financial, or legal advice. 33-17-102; 33-17-601 to 33-17-618 (1979/1997). Q. For example, health insurance companies tend to outsource their claims operations to third parties. Laws re: Administrator Certification (Health & Safety Code1522.41for GH and STRTP;1562.3for ARF;1569.616for RCFE), Regulations re: Administrator Certification re:AdministratorsandVendors. Unless the administrator is contracted with the insurer as an adminstrator and the plan is fully insured by the insurer on whose behalf the funds are held, each applicant for an administrator license must file with the application and thereafter maintain in force while so licensed, a surety bond favor of the people of The Legislature vote on state laws and draft legislation. First Consulting has researched the licensing requirements in all states, and developed three different methods to assist with TPA licensing: Contact Usfor more information, or take avirtual tourof the service for free bylogging in herewithusername:virtualtourandpassword:research, then select the Research tab. Read more, Commissioner Causey announces special enrollment period for Medicare beneficiaries affected by Moore County power outage Code 1759 to 1759.10 (1977/1984). 744.702 The latest storm is set to bring heavy mountain snow and periods of heavy rain, with an additional 1 to 3 inches of rainfall expected in areas already too saturated to absorb more water. If you need more information about recovery or resources visit the following resources: Emergency PIN 21-11-CCLD (Changes to Administrator Certification Program Fees). Current Department-approved Vendors cannot provide Department-approved courses via live-stream that are required to be held in-person. Ann. The Administrator Certification Program is legislatively mandated and designed to help ensure that prospective and existing administrators of residential facilities have the requisite initial and continuing training to appropriately care for facility residents. MGAs are typically involved in unusual lines of coverage or in geographically prohibitive areas. Answer just a few questions and our software searches public databases to detect your status and gaps. TPA niches offer broader services and prove to potential clients that your business specializes in the services they need. 40 Pa. Stat. Code 11:23-1.1 to 11:23-5.10 (2005); N.M. Stat. A third-party administrator (TPA) company provides operational services under contract to another company. For example, health insurance companies tend to outsource their claims operations to third parties. TPAs also handle liability insurance claims. I 322. 'P9E!i7.ltIqU>\^"! WebType of Bond. License Exemption Cite. Rev. 59A-12A-1 to 59A-12A-17 (1989/1999); N.M. Code R. 13.4.5.1 to 13.4.5.22 (1992/1997). Vendors may upload their documents through Automation. There are no fees collected for applying to become a TPA or for renewing a TPA license. "8, The last of the Model Law's thirteen exemptions is for an "administrator who is affiliated with an insurer and who only performs the contractual duties (between the administrator and the insurer) of an administrator for the direct and assumed insurance business of the affiliated insurer" and notes in such circumstance that the insurer "is responsible for the acts of the administrator and is responsible for providing all of the administrator's books and records to the insurance commissioner" upon request.9 Moreover, this exemption excludes employers from the general Model Law definition of "insurer. features and to analyze our traffic. Mainline Phone: 916-653-9300 "10, Accordingly, under the Model Law, a life and health insurer domiciled and holding a valid certificate of authority in a given state can lawfully engage inadministrator activities in such state without having to obtain a home state administrator license. 929 WALNUT, SUITE 300, KANSAS CITY, MO 64106| PHONE: 816.391.2730 FAX: 816.391.2755 |, Copyright 2017 First Consulting & Administration. Links to each states TPA Licensing Application forms. A third-party administrator (TPA) company provides operational services under contract to another company. As many as 46 states require licensing or other regulatory filings to act as a third-party administrator. Ohio Revised Code - Chapter 3959. Ann. Effective March 12, 2020, all TPA license applications, notice of change ofownership, and/or change of officer or directors must be submitted electronically to LHinbox@ncdoi.gov or Citrix Sharefile, or other secure electronic filing method, NO ZIP FILES. Use of our services does not create an attorney-client relationship. Sacramento, CA. Read More, All of the phone reps have been extremely professional and courteous. Be employed and under contract by an ETP employer. Code 1759 to 1759.10 (1977/1984). W. Va. Code 23-2-9 (i) states, An employer may not hire any person or group to self-administer claims under this chapter as a third-party administrator unless the person or group has been determined to be qualified to be a third administrator by the Insurance -party A person may not utilize the services of another as a third party administrator if he knows or should know the other does not have a license or the insurer authority as required by law. Every third party administrator shall have a written agreement with each insurer and with each group policyholder represented. The state licensing requirements apply when choosing a niche, as well as additional certifications. TPAs also handle liability insurance claims. "7 The Model Law defines "insurer" as "a person undertaking to provide life, annuity or health coverage or self-funded coverage under a governmental plan or church plan in this state" and expressly includes in the definition "an employer, a licensed insurance company, a prepaid hospital or medical care plan, or a health maintenance organization. "4 Finally, the written agreement must include a "provision with respect to underwriting or other standards pertaining to the business underwritten by the insurer. WebThe ACS has a NEW resource for administrators; a comprehensive list of approved administrator training courses. R.I. Gen. Laws 27-20.7-1 to 27-20.7-16 (2002); S.C. Code Ann. WebThe California Legislature has two branches, the State Assembly and the Senate. tit. Stat. Read More. Code 27-1-25-1 to 27-1-25-15 (1980/2004); 760 Ind. while there are no dot qualification requirements for a consortium or third-party administrator, the expectation is that they know all of the employer requirements and responsibilities under 49 cfr part 40 and part 382, including the related requirements of part 383 (cdl licensing), part 391 (driver qualifications), and part 392 (driving of "12 The Tennessee exemption also applies to licensed nonprofit hospitals, medical, dental and vision service corporations, and health maintenance organizations.13, Consistent with the Model Law, Tennessee requires all non-exempt administrators to enter into a detailed written agreement with the insurer for which it will be adjusting and settling claims and performing other TPA functions.14 However, the Tennessee Department of Commerce and Insurance ("Department")has interpreted "insurer" for purposes of the TPA statute somewhat more narrowly than the Model Law. Model Law 90-1, the Third Party Administrator Statute adopted by the National Association of Insurance Commissioners ("NAIC"), generally requires third party administrators ("TPAs") who underwrite, adjust or settle life, annuitiesor health claims to be licensed by the applicable state department of insurance where such TPA engages in administrator activities. Stat. tit. as a Third-Party Administrator in West Virginia . PIN 2017-03: Background Checks ` 0 With 60 years of experience, insights, and knowledge, George Hills solves problems from innovative claims management for TPA clients to a comprehensive approach to JPA management services. A personwho administers an Employers Section 125 Flexible Spending Account, Health Reimbursement Account, or Health Savings Account must also register as a TPA. 33-17-102(3)(b)(iii)(A). Get information about self-insurance and the requirements to self-insure, Apply to take the Self-insurance Administrator's examination, Determine if a person is a self-insured administrator, Licensing, registrations, certifications & permits. WebInsurance Administrator (TPA) Insurance Administrators - An insurance administrator is any person who collects charges or premiums from or who adjusts or settles claims for residents of this commonwealth in connection with life or health insurance coverage or annuities. When working for health insurance providers, TPAs help design, launch, and manage health plans. Paper filings or notifications willnot beaccepted for the immediate future. WebCalifornia has been hit with devastating wildfires and other natural disasters in both the northern and southern parts of the state. 38-51-10 to 38-51-120 (1988/1993). Fla. Stat. WebTPA Licensing PATTON COMPLIANCE TPA LICENSING Patton Compliance has successfully helped clients obtain hundreds of new third party administrator (TPA) licenses in all states that have a TPA licensing requirement. 56-6-401 to 56-6-412 (1980/1996). 83-18-1 to 83-18-29 (1991/1997). Not all TPAs offer the same services. hbbd``b`V`M"@1 W@D`T [L,Abd> State Government websites value user privacy. We do our best to calculate your filing fees 4248 Park Glen Road "5, The Model Law defines an "administrator" or "third party administrator" as "a person who directly or indirectly underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity or health coverage offered or provided by an insurer, except any of the following:" and proceeds to set out thirteen exemptions.6 The third of these exemptions is for an "insurer that is authorized to transact insurance in this state. 325 N. Salisbury Street self-insurers). Insurers intending to engage in administrator activities in one of those five states should file the appropriate certification or registration form prior to initiating such activities so as to ensure compliance with the applicable regulatory requirements. 402-H:1 to 402-H:17 (1994/1998); N.H. Code Admin. Location: and more from a single interface. Insurance Administrator licenses are renewable every two years. tit. Admin. In addition, our License Manager software helps professionals maintain their licenses by automating repetitive tasks such as tracking renewals and compliance deadlines. We make preparing and filing applications easy and handle communication with government agencies on your behalf. Ind. TPAs are companies that Self-Insured employers contract with to administer the claims administration process. A person is not to required be licensedas a TPA in this state if the person provides services exclusivelyto one or more bona fide employee benefit plans established by an employer for which the insurance laws of this State are preemptedpursuant toERISA. In those ten jurisdictions, representatives of the corresponding insurance department have recently confirmed the lack of jurisdiction over TPAs and/or that a duly licensed insurer acting as a TPA would be operating in compliance with applicable regulatory requirements. Code Ann., Ins. S.D. 0 Minneapolis, MN 55416, It's not easy to earn a FORC shield. Section 744.702 Third party administrator license; description of transacting business as third party administrator, 95814 In Alaska, Georgia and New Hampshire, regulatory approval/confirmation of the exemption is required prior to the insurer acting as an administrator. WebIt is the responsibility of each third-party administrator to know Nevadas laws, regulations and bulletins as they pertain to an individual company license. WebA person may not perform, offer to perform, or advertise any service as a third party administrator without a valid license under section 31A-25-203 and express authority If you have any questions regarding fee increases, please submit your questions to the corresponding email address listed below: The following are additionalProvider Information Notices (PINs) related to waivers of ACS licensing requirements due to the State of Emergency and COVID-19. Ariz. Rev. 4151.001 to 4151.208 (2005); 28 Tex. Stat. (last accessed Jun. As such, an entity providing claims processing on Tennessee resident employees of a self-insured employer has notheretofore been required, or permitted, tosecure an administrator license from the Department in order to engage in those activities. Pursuant to Title 8, California Code of Regulations, Section 15452, each self-insured employer or administrative agency is required to conduct the administration of self-insured workers' compensation claims through the services of a competent person or persons located in California. A chart summarizing the applicable statutory and regulatory provisions that incorporate the administrator exemption for insurers in the 51 jurisdictions referenced above follows. WebThe history of California can be divided into the Native American period (about 10,000 years ago until 1542), the European exploration period (15421769), the Spanish colonial period (17691821), the Mexican period (18211848), and United States statehood (September 9, 1850present). Code 26.1-27-01 to 26.1-27-12 (1985/2005). "1 In addition to obtaining a home state license, such person is generally required to secure a "Nonresident Administrator" license prior to engaging in administrator functions in any other state.2, In addition to securing a TPA license prior to engaging as an administrator, the Model Law further requires licensed TPAs to enter into a written agreement between the administrator and the insurer.3 The written agreement must contain "a statement of the duties that the administrator is expected to perform on behalf of the insurer and the lines, classes or types of insurance for which the administrator is to be authorized to administer. Filing fees depend on your individual situation. WebThird Party Administrator (TPA) Licensing Services Currently, forty-six (46) states require some type of license or registration to act as a Third Party Administrator. Tenn. Code Ann. Administrator Certification Section (ACS) Additional Information: Ohio Administrative Code - Chapter 3901-8-05. Tex. Web9. Other third-party administrator businesses manage employee retirement programs. WebREGISTRATION AND REGULATION OF THIRD PARTY ADMINISTRATORS (TPAs) (An NAIC Guideline) This Guideline, offered in two versions, is a revision of the Third Party Title. Read More, www.claimconnectiq.com - Claim Connect IQ. %PDF-1.6 % NAIC Model Law 90-1, Section 1.A.(13). The Administrator Certification Program is administered by the Administrator Certification Section (ACS) of the Community Care Licensing Division, Policy, Training and The adopted version clarified the intent of the drafters." Competence may be demonstrated by passing the Self-Insurance Administrator's Examination, administered for this office by PSI Examination Services. Join thousands of people who receive monthly site updates. Ohio Rev. Ins. The licensing process often Some self-insured employers choose to handle this claims administration process in-house to have a tighter control over the process. You can apply online to take the examination at www.psiexams.com. Common services TPAs provide include claims processing, client enrollment, and employee benefits. 1201 Mail Service Center A Third PartyAdministratoror TPA, asdefinedbyNCGS 58-56-2(5) is "a person who directly or indirectly solicits or effects coverage of, underwrites, collectscharges or premiums from, or adjusts or settles claims on residents of this State, or residents of another state from offices in this State, in connection with life or health insurance or annuities. The system will prompt you to select a jurisdiction, select California. Captive agents represent a single insurance company, while independent agents represent multiple insurers. LOADING PDF: If there are any problems, click here to download the file. ORS The Model Law was also amended in 1991, 1999 and 2001. Build a Morning News Brief: Easy, No Clutter, Free! *cYGabG&I-i40L D HW07F74 g` $('w!(k@AH710=i Effective July 1, 2012, PSI Examination Services will be responsible for administering the qualified claims administrator certification examination for the Office of Self-Insurance Plans (OSIP). 26, 2021). Alaska Stat. Independent adjusters investigate claims on a contractual basis for insurance companies. Legislative history of the Model Law provides that the insurance company exemption from the administrator definition "was considered at some length before adoption. 50 W Town St. Third Floor - Suite 300. In situations like that, the business is often owned or operated in part by an investment company. Yes. Your specialist will determine your 20, 200-9.500 to 200-9.800 (1994/1999). WebApplication PDF. endstream endobj 2503 0 obj <>/Metadata 153 0 R/Names 2516 0 R/Outlines 241 0 R/Pages 2498 0 R/StructTreeRoot 419 0 R/Type/Catalog/ViewerPreferences<>>> endobj 2504 0 obj <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 2505 0 obj <>stream >UKJ Wqe+wWg:T-rgi8?/.Bg/Br(, 9&Z@ !:%bln2gLS%0^aCjoz?x)L0-@u6au!8AK`Ac{iLEeu~4O8$Y Y#W3d*Yy+$yal$#r.U+;)BBii" VA'"2}aMNx]@&f;2R6t!8k1{[ https://www.oregonlegislature.gov/bills_laws/ors/ors744.html 1048 0 obj <>/Filter/FlateDecode/ID[]/Index[1032 30]/Info 1031 0 R/Length 83/Prev 252825/Root 1033 0 R/Size 1062/Type/XRef/W[1 2 1]>>stream 20-485.A(1)(c) (d). Code 683A.100 to 683A.165 (1986/2003). New fees will be assessed for the ACS exam and vendor course application processing. Code Ann. With nearly 39.2 million residents across a total area of approximately 163,696 square miles (423,970 km 2), it is the most populous Company Appointment Fees Social Security No. Rev. TPA Statutory and N.D. They offer a WebThe California Department of Motor Vehicles (DMV) is committed to promoting and protecting the privacy rights of individuals as enumerated in Article 1 of the California Constitution, the Information Practices Act of 1977, and other state and federal laws. NC Department of Insurance Managing General Agent - An agent or broker that is involved in underwriting and has other areas of authority normally handled by insurers. The licensing process often requires an immense amount of paperwork and documentation, and proof of a certain degree of education or certification. Me. Link for TPA Registration exemption from TPA License:NCGS 58-56-51(f). Licenses are issued or renewed for a period not to exceed three years. Alabama does not license third party administrators. Businesses involved in the insurance industry must be licensed to provide the services they offer. The ACS staff process applications foradministratorcertification and also approve/disapprove trainingvendorsand their proposed courses. 1977 Proc. WebThird Party Administration Services (TPA) | BRMS 888-326-2555 Customer Support Our Sites SOLUTIONS PARTNERS COMPANY LEARNING CENTER TPA Services Union & Taft Administrators can now review course lists by program to determine what courses best meet their training needs. endstream endobj 1033 0 obj <. 31A-1-301(159)(d) and 31A-1-110. DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations. California is bordered by the state of Oregon in the north, by Nevada and Arizona in the east, and by the Mexican state of Baja California in the south. I have been using Auth4D for a little over a year now. to research the requirements for the states in which you work. sdc`J'iM{~_j>:KX{2/3NI^)Ug)+ 0 633.01 to 633.17 (1991/1999) (Portions of model included). Public adjusters investigate claims on behalf of claimants, usually to determine the amount of money that can be claimed. The Model Law generally requires that prior to any person performing any function as an administrator or TPA, such "person shall apply to be an administrator in its home stateand shall receive a certificate of authority or license from the commissioner. Effective September 1, 2022 the ACS will be changing the ACS Mainline Phone hours from 8:00 a.m. 5:00 p.m. to 8:00 a.m. 12:00 p.m. To speak to a live operator, please call between the hours of 8:00 a.m. 12:00 p.m. Monday Friday. National Association of Professional Insurance Agents (PIA)Professional association that provides education and advocacy for insurance agents throughout the United States. In addition, WebThird-party administrators that are licensed or registered in another state may go online to the National Insurance Producer Registry (NIPR) to apply for a certificate of registration with the Iowa Insurance Division. First Consulting Prospective Administrators must complete an Initial Certification Training Program (ICTP) via Department-approved live training. You will also need to appoint a registered agent to receive notices of lawsuits and other legal or government notices. The system will prompt you to select a Stat. means the company contracted by the purchasing alliance to provide administrative services for the purchasing alliance and that is licensed We will always provide free access to the current law. National Association of Insurance and Financial Advisors (NAIFA)Professional association that advocates for favorable regulatory conditions for insurance agents and financial advisors. Read More, Great team and they took the time to understand where our areas of op H[o6+i(@KLNWbm1xkHMIsx.zn:[#^Ogx=00/v4/o564"3aa9oW?/qF$ hhIc0+rrw98M/V'=)c&f'9>! You consent to Ins. 744 P Street, MS 9-17-47 The following five statesnonetheless require some form of exemption certification or registration for those entities not separately and specifically licensed to perform administrator functions: Alaska, Georgia, New Hampshire, Texas, and Vermont. Currently, forty-six (46) states require some type of license or registration to act as a Third Party Administrator. Through License Manager, you can also access LicenseIQ our extensive, proprietary database of nationwide licensing requirements Adjuster - A person or firm that is paid to adjust, investigate, and negotiate claim settlements. From there please follow the instructions. National Insurance Producer Registry (NIPR)An affiliate of the NAIC that provides streamlined and uniform producer licensing processes. 15. We also share information about your use of our site with our Surplus Lines Insurer - An insurance carrier that takes on risks that a licensed carrier is unwilling to insure. The State of California is located in the western (Pacific) region of the United States. and can explain what steps you need to take in order to ensure you remain compliant with state and federal regulations. WebPaper TPA Renewal Application (Individual only) Please submit Third Party Administrator supporting documentation to: Ohio Department of Insurance. Third-party administrators must also complete the TPA Application Checklist with application and renewal submissions. 2514 0 obj <>/Filter/FlateDecode/ID[<2826286D20D0C6429D4CF119D73D575A><2826286D20D0C6429D4CF119D73D575A>]/Index[2502 25]/Info 2501 0 R/Length 71/Prev 186722/Root 2503 0 R/Size 2527/Type/XRef/W[1 2 1]>>stream Rev. Eligibility Title Agent - Title agents sell insurance that protects real estate owners against loss of ownership of a property due to a legal claim. Admin. On October 17, 2022, Governor Newsom issued an announcement that the COVID-19 State of Emergency (SOE) will end on February 28, 2023. Regulatory support organization that is governed by state insurance regulators to be held in-person choose to this. Not easy to earn a FORC shield N.H. Code Admin and prove to potential that. Of money that can be claimed requirements for the immediate future live training a certain degree of education or.... Morning News Brief: easy, no Clutter, Free 11:23-5.10 ( 2005 ) ; 11 N.C. Admin their. Provides streamlined and uniform Producer licensing processes need to appoint a registered agent to receive notices of lawsuits other! A single insurance company, while independent agents represent multiple insurers a chart summarizing the applicable and. 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Renewals and Compliance deadlines information on the basic rules that govern claims administration,... By automating repetitive tasks such as tracking renewals and Compliance deadlines: If there are no collected. ( 1992/1997 ) to provide the services they need additional certifications legislative history of the NAIC that provides and... Answer just a few questions and our software searches public databases to detect status! Competence may be demonstrated by passing the Self-Insurance administrator 's Examination, administered for office. Addition, our license Manager software helps professionals maintain their licenses by automating repetitive tasks such as tracking renewals Compliance. No fees collected for applying to become a TPA or for renewing a TPA license: NCGS (! Federal regulations notices of lawsuits and other natural disasters in both the and! ` $ ( ' w the ACS staff process applications foradministratorcertification and approve/disapprove! 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