Aetna Drugs Prior Authorization Forms

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Prescription Drug Prior Authorizathion Request Form …

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8 hours ago authorization request or is a prior authorization request for medication assisted treatment for substance abuse disorders. GR-69025-1 CO (8-20) Aetna complies with applicable Federal civil rights laws and does not unlawfully discriminate,

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Pharmacy Prior Authorization Request Form Aetna

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844-802-14125 hours ago Fax completed prior authorization request form to 844-802-1412 or submit Electronic Prior Authorization through CoverMyMeds® or SureScripts. All requested data must be provided. Incomplete forms or forms without the chart notes will be returned. Pharmacy

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Forms and applications for Health care professionals Aetna

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3 hours ago Find forms and applications for health care professionals and patients, all in one place. It's easy to update a provider address, phone number, fax number or email address, or initiate an out-of-state move or a change in provider group. For Part D prior authorization forms, see the Medicare section.

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Pharmacy Prior Authorization Forms Aetna

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855-799-25548 hours ago Pharmacy Prior Authorization Forms. To submit a request for pharmacy prior authorization, please fax your request to 1-855-799-2554 and include all documentation to support the medical necessity review. You can also submit your request by phone by calling: Medicaid at 1-800-441-5501. Florida Healthy Kids at 1-844-528-5815.

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Pharmacy prior authorization Aetna

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866-212-28514 hours ago Aetna Better Health requires prior authorization for certain drugs on the formulary drug list and for all non-formulary drug requests. You may now request prior authorization of most drugs via phone by calling the Aetna Better Health Pharmacy Prior Authorization team at 1-866-212-2851.You can also print the required prior authorization form below and fax it along with …

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PRESCRIPTION DRUG PRIOR AUTHORIZATION OR STEP …

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4 hours ago Please fill out all applicable sections on both pages completely and legibly . Attach any additional documentation that is important for the review, e.g. chart notes or lab data, to support the prior authorization or step therapy exception request.

File Size: 109KB
Page Count: 2

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Prior Authorization Information Aetna

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7 hours ago Prior Authorization can ensure proper patient selection, dosage, drug administration and duration of selected drugs. PA Forms for Physicians When a PA is needed for a prescription, the member will be asked to have the physician or authorized agent of the physician contact our Prior Authorization Department to answer criteria questions to

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Specialty Medication Precertification Request Aetna

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866-752-70212 hours ago Aetna Precertification Notification Phone: 1-866-752-7021 FAX: 1-888-267-3277 This form is for use ONLY where a drug specific specialty medication precertification request form does not exist. Any person who knowingly files a request for authorization of coverage of a medical procedure or service with the intent to injure, defraud or

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Procedures, programs, and drugs that require precertification

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866-752-70217 hours ago For the following services, providers call 1-866-752-7021 or fax applicable request forms to 1-888-267-3277, with the following exceptions: • For precertification of pharmacy-covered specialty drugs (noted with*) when you are enrolled in a commercial plan, yourprovider willcall 1-855-240-0535. Or, they can fax applicable request forms to

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Page Count: 6

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MINNESOTA UNIFORM FORM FOR PRESCRIPTION DRUG …

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9 hours ago 2. Request a prior authorization (PA) for a prescription drug. Prescription drug prior authorization requests are requests for pre-approval from a payer for specified medications or quantities of medications. • Minnesota Statutes, section 62J.497, subd. 5 requires that by January 1, 2016, drug PA requests must be accessible

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Pharmacy Authorization Forms Aetna Better Health

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5 hours ago Pharmacy Authorization Forms. This is an accordion control.The folowings tab will be activated by enter or space bar. Prior Authorization Forms A - O. Click "ctrl + f" and type in the name of the drug to search. Common Formulary Prior Authorization Request …

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Aetna California Prescription Drug Prior Authorization

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877-269-99168 hours ago Fax this form to: 1-877-269-9916 OR Submit your request online at: www.availity.com CALIFORNIA PRESCRIPTION DRUG PRIOR AUTHORIZATION OR STEP THERAPY EXCEPTION REQUEST FORM Patient Name: ID#: Instructions: Please fill out all applicable sections on both pages completely and legibly.

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Free Aetna Prior (Rx) Authorization Form PDF – eForms

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5 hours ago An Aetna prior authorization form is designated for medical offices when a particular patient’s insurance is not listed as eligible. This form asks the medical office for the right to be able to write a prescription to their patient whilst having Aetna cover the cost as stated in the insurance policy (in reference to prescription costs).

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MASSACHUSETTS STANDARD FORM FOR MEDICATION …

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4 hours ago Massachusetts Collaborative — Massachusetts Standard Form for Medication Prior Authorization Requests April 2019 (version 1.0) F.atient Clinical Information P *Please refer to plan-specific criteria for details related to required information.

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Prescription Drug Prior Authorization Form Aetna 2

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1 hours ago Prescription Drug Prior Authorization Form - Aetna 2 Iowa Insurance Division.

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Aetna Prior Authorization Forms CoverMyMeds

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5 hours ago Aetna’s Preferred Method for Prior Authorization Requests. CoverMyMeds is the fastest and easiest way to review, complete and track PA requests. Our electronic prior authorization (ePA) solution is HIPAA-compliant and available for all plans and all medications at no cost to providers and their staff. About CoverMyMeds.

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Free AETNA Prior Prescription (Rx) Authorization Form PDF

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9 hours ago The AETNA prescription prior authorization form is a document that is used to justify the prescribing of a particular medication not already on the AETNA formulary. The patient’s personal insurance information, their current condition, and the previous drugs/therapies attempted to remedy their condition must be supplied.

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Aetna Drugs Prior Authorization Forms druglist.info

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855-799-2554Just Now Pharmacy Prior Authorization Forms - Aetna. Health (8 days ago) Pharmacy Prior Authorization Forms. To submit a request for pharmacy prior authorization, please fax your request to 1-855-799-2554 and include all documentation to support the medical necessity review. You can also submit your request by phone by calling: Medicaid at 1-800-441-5501.

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Free Prior (Rx) Authorization Forms PDF – eForms

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9 hours ago Prescription prior authorization forms are used by physicians who wish to request insurance coverage for non-preferred prescriptions.A non-preferred drug is a drug that is not listed on the Preferred Drug List (PDL) of a given insurance provider or State. On the prior authorization form, the person making the request must provide a medical rationale as to why the chosen …

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Resources and Forms Aetna Student Health

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888-472-11284 hours ago For prescription drug claims, to receive reimbursement, you will need to submit a claim form and the prescription receipt to Aetna. Print an Aetna Prescription Drug Claim Form. Fax your completed Aetna Prescription Drug Claim Form and receipts to 1-888-472-1128 or mail it to: Aetna Pharmacy Management. P.O. Box 52444.

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Botox® (onabotulinumtoxinA) Injectable Medication Aetna

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866-752-70214 hours ago Aetna Precertification Notification . Phone: 1-866-752-7021. FAX: 1-888-267-3277 . For Medicare Advantage Part B: (All fields must be completed and legible for Precertification Review) Please Use Medicare Request Form . Please indicate: Start of treatment: Start date / / Continuation of therapy, Date of last treatment / /

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Prior Authorization Request Form

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800-711-45558 hours ago If the patient is not able to meet the above standard prior authorization requirements, please call 1-800-711-4555. For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-800-527-0531. Please note: All information below is required to process this request

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Novologix Prior Authorization Form Fill and Sign

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3 hours ago Prior Authorization Aetna Medicaid California - Aetna Better Health Call your physician and ensure they have received a call from the pharmacy. Ask the physician (or his staff) how long it will take them to fill out the necessary forms.

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Get Forms for your Medicare Plan Aetna Medicare

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Just Now Find the Aetna Medicare forms you need to help you get started with claims reimbursements, Aetna Rx Home Delivery, filing an appeal and more. Skip to main content. If you were billed by a pharmacy for a covered prescription drug, mail us your completed form to request reimbursement.

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Aetna Medicare D Prior Authorization Cancer

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724-741-49531 hours ago Aetna Medicare Prior Authorization. Health Offer Details: Coverage Decisions, Appeals and Grievances Aetna Medicare.Health (7 days ago) If you are an Employer Group Medicare Advantage member, please use the below forms: Print a claim denial appeal form. Print an authorization appeal form Fax: 1-724-741-4953 Mail: Aetna Medicare Part C Appeals PO …

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Michigan Prior Authorization Request Form for Prescription

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7 hours ago Michigan Prior Authorization Request Form For Prescription Drugs Instructions . Important: Please read all instructions below before completing FIS 2288. Section 2212c of Public A ct 218 of 1956, MCL 500.2212c, requires the use of a stand ard prior authorization form

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Request for Medicare Prescription Drug Coverage Aetna

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2 hours ago I need a drug that is not on the plan’s list of covered drugs (formulary exception).* I have been using a drug that was previously included on the plan’s list of covered drugs, but is being removed or was removed from this list during the plan year (formulary exception).* I request prior authorization for the drug my prescriber has prescribed.*

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Covered and noncovered drugs Aetna

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9 hours ago prior authorization for medical necessity. If you continue using one of these drugs without prior approval, you may be required to pay the full cost. Ask your doctor to choose one of the generic Aetna Pharmacy Management administers, but does not offer, insure or otherwise underwrite the

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aetna pa form for medications todayconsumer.com

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3 hours ago Aetna pa forms for medications - lvtbs.theenvirocenter.org. theenvirocenter.org. Prescriptions must be filled at an Aetna Better Health network pharmacy, and. .. the required prior authorization form and fax it along with

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MedicareMedicaid Part D Prescription Drugs Aetna

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855-676-57721 hours ago Call us toll-free to get the most recent drug list at 1-855-676-5772, 24 hours a day, seven days a week. Pharmacy Prior Authorization. Aetna Better Health Premier Plan requires you or your physician to get prior authorization for some drugs. This means that you need to get approval from us before you fill your prescriptions.

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Aetna Better Health Prior Authorization US Legal Forms

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7 hours ago US Legal Forms enables you to rapidly make legally-compliant papers according to pre-created online samples. Prepare your docs in minutes using our straightforward step-by-step guide: Find the Aetna Better Health Prior Authorization you want. Open it up using the cloud-based editor and start adjusting.

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Prescription Drug Information & Resources Aetna Medicare

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3 hours ago Prior authorization, quantity limits & step therapy. Some drugs have rules you need to follow before we cover them. These include: Prior authorization. You or your doctor needs approval from us before we cover the drug. Quantity limits. For certain drugs, we limit the amount you can get. Step therapy.

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Viscosupplementation Injectable Aetna Precertification

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6 hours ago Orthovisc (high molecular weight form of hyaluronic acid) Yes No Supartz (sodium hyaluronate) Yes No Synvisc (hylan G-F 20) Yes No Synvisc One (hylan G-F 20) Yes No *If Aetna Specialty Pharmacy is the dispensing pharmacy, patient benefits will be verified before product is shipped.

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Pharmacy Resources Banner Aetna

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4 hours ago We understand your life is busy. And getting your medicine how and when it fits your life really matters. As a BannerAetna member, you receive pharmacy benefits through Aetna. We care about your safety and satisfaction, so we make sure you get the support you need to make the best choices for your health, safety and budget.

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Prior Authorization Medicare Prescription Drug Coverage

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9 hours ago Prior Authorization Form - SilverScript Subject: SilverScript Prior Authorization Form to request Medicare prescription drug coverage determination. Mail or fax this PDF form. Created Date: 9/16/2015 10:57:04 AM

File Size: 93KB
Page Count: 4

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Prior Authorization Forms Banner Health

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8 hours ago Prior Authorizations Forms. Please include ALL pertinent clinical information with your Medical or Pharmacy Prior Authorization request submission. To ensure that prior authorizations are reviewed promptly, submit request with current clinical notes and relevant lab work. Electronic prior authorization (ePA) helps you spend less time on PA’s

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Aetna Better Health of Texas Participating Provider Prior

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3 hours ago Pharmacy Prior Authorization To obtain a Prior Authorization for a medication, doctors can call Aetna Better Health of Texas at: Medicaid STAR 1 …

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4RX Drugstore: Aetna prior authorization form for nexium

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6 hours ago Drug exanthems the antigen-binding cleft of the ileocolic and middle colic blood supplies along with mal tumors form prior aetna authorization for nexium from. These results highlight the need for fna biopsy of the medications most effective treatment involves either red blood cells.

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Provider Pharmacy Prior Authorization Request Form

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855-656-0363Just Now Procedure for obtaining pharmacy prior authorization - To obtain a Prior Authorization, providers can call CVS Caremark at 1-855-656-0363 or fax an authorization form designed specifically for pharmacy requests. Download the forms here and fax the request to …

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CVS/Caremark Prior (Rx) Authorization Form PDF – eForms

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1 hours ago A CVS/Caremark prior authorization form is to be used by a medical office when requesting coverage for a CVS/Caremark plan member’s prescription. A physician will need to fill in the form with the patient’s medical information and submit it to CVS/Caremark for assessment. In doing so, CVS/Caremark will be able to decide whether or not the requested prescription is included in …

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Tremfya Insurance Coverage Prior Authorization

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1 hours ago A standardized, or "uniform," prior authorization (PA) form may be required in certain states to submit PA requests to a health plan for review, along with the necessary clinical documentation. These standard forms can be used across payers and health benefit managers.

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Texas Standard Prior Fax this form to: 18772699916 OR

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4 hours ago tx-pharmacy-precert-form Author: Aetna Subject: tx-pharmacy-precert-form Keywords: Precertification, Prior Authorization, Pharmacy, Prescription Drugs, Medical Exception Created Date: 8/4/2015 10:07:23 AM

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CVS Caremark® Mail Service Pharmacy Aetna Medicare

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6 hours ago Link to PDF. Mail Service Order Form (Español) Link to PDF. CVS Caremark. PO BOX 659541. SAN ANTONIO, TX 78265-9541. Let us know how you want to pay for your order. That way you can avoid processing delays. You have options such as all major credit and debit cards, electronic check and more.

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Free Prior Prescription (RX) Authorization Forms PDF Word

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3 hours ago The prior prescription authorization forms are used by a doctor’s office to make a request to an insurer or government office if a drug is covered by the patient’s health insurance. The form should list the patient’s name, types of symptoms, and the reason for the drug’s medication over other approved types. After the form is complete it can be emailed or faxed and usually an …

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Commercial Drug Prior Authorization Forms Cigna

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4 hours ago Commercial Drug Prior Authorization Forms. To better serve our providers, business partners, and patients, the Cigna Coverage Review Department is transitioning from PromptPA, fax, and phone coverage reviews, also called prior authorizations, to Electronic Prior Authorizations. ePAs save time and help patients receive their medications faster.

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Aetna to Require Prior Authorization in 4 States Gawenda

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1 hours ago Aetna to Require Prior Authorization in 4 States. September 5, 2018 by Rick Gawenda 10 Comments. Effective September 1, 2018, Aetna will begin requiring prior authorization for physical therapy and occupational therapy in 4 states. The 4 states are. This content is for Gold Members only.

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Frequently Asked Questions

What medications need prior authorization?

Category * Drug Class Drugs Requiring Prior Authorization for Medical Necessity 1 Formulary Options (May Require Prior Authorization) High Blood Pressure * Angiotensin II Receptor Antagonists ATACAND DIOVAN EDARBI TEVETEN. candesartan, eprosartan, irbesartan, losartan, telmisartan, valsartan , BENICAR.

Is Provigil covered by Aetna?

Provigil is currently excluded from coverage for members enrolled in prescription benefit plans that use a closed formulary, unless a medical exception is granted. Aetna considers this medication to be medically necessary for those members who meet ANY of the following criteria: A documented diagnosis of one of the following:

What is Aetna signature PPO?

Aetna Signature Administrators is the Preferred Provider Organization (PPO). Principal is the claims administrator responsible for processing claims and pre-authorizing certain services.

What is prior authorization for prescription drugs?

Prior authorization is a requirement that your physician obtains approval from your health care provider before prescribing a specific medication for you or to performing a particular operation.

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