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Pension and Employee Benefit Law

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New Federal Health Claims & Appeals Laws & Regulations

for 193 Million Americans

Effective 09-23-2010

©2010, Jin Zhou, ERISAclaim.com

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President Obama Signing Health Bill on 03/23/2010

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New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept. 23, 2010 for 193 Million Americans

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PPACA Webinars For Hospital CFOs


PPACA Webinars for Hospital CFOs: Most Sweeping Health Reform Revenue Laws & "Overpayment" Crisis

 

Biweekly, Two-hours/Session, $650/Session

 

How to Register?

 

  1. Click this link to pay: $650/Per Session;

  2. Select one of the dates of your choice below;

  3. You will receive a Webinar Password after your payment is processed.

  4. You may also submit your request of dates not on this list, we will accommodate your schedule if possible.

 

Select your choice for a session now by clicking a date below:

 

Thu, May 19, 2011 12:00 PM - 2:00 PM CDT

Thu, Jun 2, 2011 12:00 PM - 2:00 PM CDT

Thu, Jun 16, 2011 12:00 PM - 2:00 PM CDT

Thu, Jun 30, 2011 12:00 PM - 2:00 PM CDT

Thu, Jul 14, 2011 12:00 PM - 2:00 PM CDT

Thu, Jul 28, 2011 12:00 PM - 2:00 PM CDT

Thu, Aug 11, 2011 12:00 PM - 2:00 PM CDT

Thu, Aug 25, 2011 12:00 PM - 2:00 PM CDT

Thu, Sep 8, 2011 12:00 PM - 2:00 PM CDT

Thu, Sep 22, 2011 12:00 PM - 2:00 PM CDT

Thu, Oct 6, 2011 12:00 PM - 2:00 PM CDT

Thu, Oct 20, 2011 12:00 PM - 2:00 PM CDT

 

The Webinars provide hospital CFOs with timely critical understanding and implementation of the new Federal Health Reform Laws and PPACA Claims Regulations governing hospital revenue cycle for all group health plan and individual policy claims, the most sweeping reimbursement law changes since the enactment of Medicare 45 years ago. The CFO Webinars are urged by the Congressional GAO PPACA Appeal Report on March 16, 2011 and prompted by the recent federal court decision on April 21, 2011 against a hospital with million-dollar claims.

PPACA Webinars for Hospital CFOs will cover the following topics:

 

  1. Health Reform Law PPACA Claims Regulations, Effective Date Sep. 23, 2010, with only less than 1% requirements extended with enforcement date until 01/01/2012;

  2. PPACA Claims Regulations govern most claims outside Medicare and Medicaid, critically and regulatorily control hospital revenue cycle, more important than Medicare claim regulations;

  3. Unprecedented federal protections for Hospital Emergency Services regardless of network participation, and for non-emergency services by out-of-network hospitals;

  4. PPACA appeals regulations with true prompt pay protections for Internal and External Appeals;

  5. Recent federal appellate court rulings against an in-network Hospital with million-dollar claims brought under PPO contract without ERISA compliance;

  6. Congressional GAO PPACA report on national denial rates and appeal rates with successful reversal of the original denials;

  7. How to cope with the current overpayment recoupment crisis under PPACA and ERISA laws.

  8. The importance of and how to establish hospital PPACA and ERISA Appeals Department, with Certified PPACA and ERISA Claim Specialists.

 

 

PPACA Webinars for Hospital CFOs: Most Sweeping Health Reform Revenue Laws & "Overpayment" Crisis 

ERISAclaim.com Announced PPACA Webinar For Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue Laws & Overpayment Recoupment Crisis,” To Assist Hospitals In Compliance With PPACA, Federal Claims & Appeals Regulations, With Certified PPACA Claim Specialists & PPACA Appeals Department.

Hanover Park, IL (PRWEB) April 27, 2011

 

On April 27, 2011, ERISAclaim.com announced PPACA Webinars for Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue Laws, Consumer Protections and Overpayment Crisis.” The Webinars provide hospital CFOs with timely critical understanding and implementation of the new Federal Health Reform Laws and PPACA Claims Regulations governing hospital revenue cycle for all group health plan and individual policy claims, the most sweeping reimbursement law changes since the enactment of Medicare 45 years ago. The CFO Webinars are urged by the Congressional GAO PPACA Appeal Report on March 16, 2011 and prompted by the recent federal court decision on April 21, 2011 against a hospital with million-dollar claims. The webinars are scheduled biweekly, two-hours per session, at $650 per session.

 

PPACA adopted federal ERISA law as the minimum “PPACA Internal Appeal Standards” for all ERISA and non-ERISA plans. It has been more than six months since PPACA claims regulations went into effect on Sep. 23, 2010. PPACA Claims Regulation compliance is now a federal mandate for all hospitals with unprecedented and the provider protections. (http://www.dol.gov/ebsa/healthreform/)

 

PPACA Claims Regulations, § 2590.715-2719A (b), provide all hospitals with unprecedented federal protections for emergency services and out-of-network hospitals.

 

On March 16, 2011, Congress released the PPACA mandated GAO Report, indicating that only a very small portion of denied claims were actually appealed (0.5% in Ohio), but when appealed, 39 to 59% reversed the initial denials.

 

“Further, the data GAO reviewed indicated that coverage denials, if appealed, were frequently reversed in the consumer's favor. For example, data from four of the six states on the outcomes of appeals filed with insurers indicated that 39 percent to 59 percent of appeals resulted in the insurer reversing its original coverage denial. Data from a national study conducted by a trade association for insurance companies on the outcomes of appeals filed with states for an independent, external review indicated that coverage denials were reversed about 40 percent of the time.” (http://www.gao.gov/products/GAO-11-268)

 

A few, if any, out of all 5795 hospitals, have implemented PPACA Claims Regulations with PPACA Claim Specialists or PPACA Appeals Departments, while $75.5 billion in unpaid hospital care was reported by AHA for 2009, according to Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

 

On April 21, 2011, federal appeals court ruled against an in-network Hospital, with claims over $1 million, based on ERISA complete preemption.

 

According to the Court documents - Montefiore Medical Center v. Teamsters Local 272, Docket No. 10-1451-cv., United States Court of Appeals, Second Circuit, Decided: April 21, 2011:

 

“This case is yet another act in the all-too-familiar drama involving patients, their health care providers, and their health care benefit plans. The question presented is whether a health care provider's breach of contract and quasi-contract claims against a benefit plan established pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq., are completely preempted by federal law under the two-pronged test for ERISA preemption established in Aetna Health Inc. v. Davila, 542 U.S. 200, 209 (2004). We hold: (1) an "in-network" health care provider may receive a valid assignment of rights from an ERISA plan beneficiary pursuant to ERISA § 502(a)(1)(B),1 the provision setting forth ERISA's civil enforcement scheme; (2) where a provider's claim involves the right to payment and not simply the amount or execution of payment2—that is, where the claim implicates coverage and benefit determinations as set forth by the terms of the ERISA benefit plan, and not simply the contractually correct payment amount or the proper execution of the monetary transfer3—that claim constitutes a colorable claim for benefits pursuant to ERISA § 502(a)(1)(B); and (3) in the instant case, at least some of plaintiff's claims for reimbursement are completely preempted by federal law; furthermore, the remaining state-law claims are properly subject to the District Court's supplemental jurisdiction.”

 

For a copy of the official court decision:

http://ERISAclaim.com/Court_ERISA_Hospitals.pdf

 

PPACA Webinars for Hospital CFOs will cover the following topics:

1.    Health Reform Law PPACA Claims Regulations, Effective Date Sep. 23, 2010, with only less than 1% requirements extended with enforcement date until 01/01/2012;
2.    PPACA Claims Regulations govern most claims outside Medicare and Medicaid, critically and regulatorily control hospital revenue cycle, more important than Medicare claim regulations;
3.    Unprecedented federal protections for Hospital Emergency Services regardless of network participation, and for non-emergency services by out-of-network hospitals;
4.    PPACA appeals regulations with true prompt pay protections for Internal and External Appeals;
5.    Recent federal appellate court rulings against an in-network Hospital with million-dollar claims brought under PPO contract without ERISA compliance;
6.    Congressional GAO PPACA report on national denial rates and appeal rates with successful reversal of the original denials;
7.    How to cope with the current overpayment recoupment crisis under PPACA and ERISA laws.
8.    The importance of and how to establish hospital PPACA and ERISA Appeals Department, with Certified PPACA and ERISA Claim Specialists.

 

To register PPACA Webinars for Hospital CFOs:

http://www.erisaclaim.com/erisa_for_hospitals.htm

 

Located in a Chicago suburb in Illinois, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers. For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

 

###

 

 

 

            Members: $0.00;  Non-Members: $15.0,                       

   by 2/21/2011      

February 22, 2011

Webinar on Health Reform Law 2011 Mandates for Claims Reimbursement and Appeals
12:00 PM - 1:00 PM PST
FREE for HFMA Members; $15 for Non-Members
Click here to download the event flyer
Add to outlook calendar

 

Webinar on Health Reform Law 2011 Mandates for Claims Reimbursement and Appeals

 

Tuesday, February 22, 2011 to Tuesday, February 22, 2011

Webinar:


Health Reform Law or PPACA, has been effective since September 23, 2010, with an enforcement grace period until July 1, 2011 for strict and full enforcement, for all group health plans and individual policies as well as all healthcare providers. PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare. It is extremely important for all hospitals and providers to know and comply with PPACA.

 

ATTENDEE REGISTRATION

Registration Fees:

Members: $0.00

Non-Members: $15.00

Contact
Geli Argao
office@hfma-nca.org
(925) 828-4532

by 2/21/2011

 

 

 

Objectives of the Webinar:

  • Provide a brief overview of the DOL Health Reform Law claims regulations website: http://www.dol.gov/ebsa/healthreform/

  • Understand that new federal Health Reform Law and claims regulations are effective now, and they are federal mandates, not optional, for all non-Medicare healthcare claims

  • Understand the basic scope of new federal Health Reform Law and claims regulations, PPACA

  • Provide basic understanding of new federal internal and external appeals processes

  • Provide basic understanding of ERISA claims regulations

  • Provide basic understanding of new federal external appeals regulations

  • Present options available to master new federal claims regulations and become PPACA/ERISA Claims Specialist for maximal compliant claims reimbursement
     

About the Speaker:

Dr. Jin Zhou is a national speaker, consultant, author and publisher of healthcare PPACA / ERISA claim denials and appeals, regulation education and compliance. For the past 10 years, Dr. Zhou taught hundreds of free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals, attorneys and commercial companies. He is frequently sought for ERISA litigation support. Dr. Jin Zhou is regarded as the “Godfather of ERISA claims” for healthcare providers. He pioneered, authored and published the nation’s first ERISA Healthcare Claim Appeal System in a CD book, and the nation’s first ERISA / PPACA website: www.ERISAclaim.com, exclusively for ERISA healthcare claim denials, appeals, claim regulation education and compliance. www.ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country.

 

 

ERISAclaim.com Free ERISA Webinars


2010 Free Webinars

 

ERISA Webinar Handout | 10-22-2010

New Free Webinars Announced to Discuss the Latest Federal Court Overpayment Lawsuit Ruling and New Obama Health Laws for the Skyrocketing $6 Trillion Overpayment Recoupment Market 03-29-2010, Hanover Park, IL

 

The Latest Federal Court Overpayment Lawsuit Ruling and New Obama Health Laws

 

Register for a session now by clicking a date below:

 

Fri, May 7, 2010 1:30 PM - 2:00 PM CDT

 

Fri, Jun 4, 2010 1:30 PM - 2:00 PM CDT

To Discuss The Latest And The First Federal Court Ruling On March 18, 2010 That A PPO Participating Provider’s Lawsuit Against Anthem BCBS, For The Alleged Wrongful Overpayment Recoupment and Even Withholding From Different Patients, Is Completely Governed By Federal Law, ERISA, Rather Than PPO Contracts And State Laws.

New Obama Health Reform Laws That Mandate ERISA Appeals For All Group Health Plans And Health Providers.

“It is extremely important for all health plans, TPA’s, managed care operators and healthcare providers to comply with governing federal laws in resolving and prevailing all overpayment claims disputes and overpayment recoupment and withholding,”

 

Register for a session now by clicking a date below:

 

Fri, Apr 2, 2010 1:30 PM - 2:00 PM CDT

 

Fri, May 7, 2010 1:30 PM - 2:00 PM CDT

 

Fri, Jun 4, 2010 1:30 PM - 2:00 PM CDT

 

  

Once registered you will receive an email confirming your registration
with information you need to join the Webinar.

 

System Requirements
PC-based attendees
Required: Windows® 7, Vista, XP, 2003 Server or 2000

 

Macintosh®-based attendees
Required: Mac OS® X 10.4.11 (Tiger®) or newer

 

 

Embezzlement Recovery Services (ERS)

for  Midsized and Large ERISA Health Plans

        “Anti-fraud initiative is not complete until and unless the recouped overpayment money originated from the plan assets is finally returned to the original self-insured health plans, or the fake anti-fraud crusaders are the real fraud culprit”, said Dr. Jin Zhou, the president of ERISAclaim.com

Free Webinar Registration for Self-insured Health Plans

 

Space is limited and only open to self-insured health plans

Webinar Title: Overpayment Recoupment Embezzlement Recovery

Reserve your free Webinar seat now at

https://www1.gotomeeting.com/register/857663256

Date: Wednesday, December 23, 2009, Time: 12:30 PM - 1:00 PM CST

https://www1.gotomeeting.com/register/177031920

Date: Wednesday, January 27, 2010, Time: 12:30 PM - 1:30 PM CST

https://www1.gotomeeting.com/register/514303152

Date: Monday, February 22, 2010,  Time: 12:30 PM - 1:00 PM CST

Free Overpayment Webinar Announced For Self-insured Health Plans To Get Immediate Relief from New $1 Trillion Overpayment Recoupment Embezzlement Market 11-23-2009, Hanover Park, IL

 

 


2009 Free Webinars

 

 

Register for a session now by clicking a date below:

 

Fri, Dec 4, 2009 1:00 PM - 2:00 PM CST

 

Mon, Dec 14, 2009 1:00 PM - 2:00 PM CST

 

All of Our ERISA Webinars are Free and 60 Minutes for Each Session. All Time Zone Is U.S. Central Standard Time.

 

Free Webinars on New Health Reform

for Healthcare Providers

 

  1. No One Else Has Talked About How Both House and Senate Bills Will Harm or Protect Healthcare Providers for Their Reimbursement Rights, When Every One Is Talking About How The Health Bills Will Be Financed;

  2. Both House and Senate Bills Have Complete Similarities On The Internal and External Appeal Laws For All Health Plans;

  3. How Healthcare Providers Will Be Winning Or Losing Under The New U.S. Healthcare Reform Laws after 2009?

This is the only extensive analysis on both House and Senate Bills (they happened to be same) on Provider's Rights and our Reimbursement Rights after the New Year in the New Obama Health Laws,  when no one else in public has talked about this most important issue for all of us: How do WE, providers, get paid or protected.

New Health Reform

for Healthcare Providers

&

ERISA Basics &  Healthcare Claim Denial and Appeals

 

Register for a session now by clicking a date below:

 

Fri, Dec 4, 2009 1:00 PM - 2:00 PM CST

 

Mon, Dec 14, 2009 1:00 PM - 2:00 PM CST

 

ERISA Basics &  Healthcare Claim Denial and Appeals

Free Webinar Topics To Be Covered

PPT: 20 minutes, Q&A: 10 minutes = 30 minutes total

  1. New U.S. Healthcare Reform Has Made ERISA Claim Regulation as the Claim Regulation for All Health Plans in the Future.

  2. The Latest U.S. Supreme Court Rulings On ERISA And Healthcare:  ERISA Governs Completely (100%) Claim Dispute And Denial For Benefits With All Employer Sponsored Plans, Both Self-Insured And Fully-Insured, And ERISA Pre-Empts Completely (100%) Any And All State Laws And Managed Care Contract For Claim Benefits Dispute.

  3. Federal Law, ERISA Basics, and Your Claims
  4. How To Identify ERISA Plans In 5 Seconds As Soon As Your Patients Completely Registrations;
  5. Statutory ERISA Definition On A "Denial", Any Payment Or Overpayment Refund Less Than 100% Claimed,
  6. How Can A Provider Completely Enjoy Or Be Entitled To The Same ERISA Rights (Verification, Direct Payment Without PPO And Appeal....) As Your Patients Under ERISA?
  7. How To Appeal Commonly Seen Healthcare Claim Denials Or Delays.
  8. Statutory ERISA Definition On A "Denial", Any Payment Or Overpayment Refund Less Than 100% Claimed,
  9. Overpayment Refund Demand = Retrospective Or Retroactive Benefits Denial = Triggers ERISA Appeal Process For Full And Fair Reviews, "Statute Of Limitation" Or Timeline Under Federal Law ERISA For Overpayment Denials, Burden Of Proof And Disclosure Obligations By The Payer;
  10. How To Appeal Overpayment Refund Denials Or Demand.
  11. Latest Nationwide ERISA & RICO Class Action Lawsuits By Providers Against Payers Over Overpayment Refund Dispute

Please send an E-mail to ERISAclaim@aol.com with your name, Co. professional title and contact info as well as the session you would like to attend, we will send you our Free Webinar Log-in Info.

 

The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL

"New Health Care Reform Bill, The Affordable Health Care for American Act, Was Passed by the House Of Representatives Saturday Night, and Is Expected to Be Signed into Law by the President Obama by the End of the Year with Absolute Confidence. ERISAclaim.com Announced the First Claim Specialist Certification Class Specifically for the Compliance with the New Federal Healthcare Law for 96% of Americans"

ERISAclaim.com Is Pleased to Announce Free ERISA Webinars for Healthcare Providers, Coding & Billings Professionals, Payers, TPA's & MCO Professionals, and Healthcare Attorneys.

 

We will have in-depth discussion at our free Webinars on why and how ERISA claim regulation will be incorporated in it entirety into the New Obama Health Plan for All, The Affordable Health Care for American Act, for 96% of Americans.

 

 

##################################

 

ERISA, Employee Retirement Income Security Act of 1974, is a federal law that governs and regulates healthcare claims for estimated more than 170 million Americans who obtained health insurance or benefits from employment in private sector, for both self-insured and fully-insured (through purchase of insurance) health plans. ERISA law completely (100%) preempts, supersedes and invalidates any and all state laws and private managed-care contracts for PPOs and HMOs in any and all dispute over denial of benefits from an ERISA plan. ERISA regulates and governs healthcare claims which include the paid ERISA healthcare claims in more than 50% of $2.4 trillion, 16.6% of GDP, of the national health expenditure in 2008, and also include the denied healthcare claims, legitimately or wrongly for appealable claims, in more than 50% of $5 trillion in the aggregated denied healthcare claims in 2008. More than 60-70% of healthcare claim denials from insurance companies and managed-care third-party payers by employer-sponsored plans are due to ERISA regulated plan or policy coverage, limitations and exclusions rather than traditional billing, coding, medical necessity and managed care contracting or participation dispute. Although in the past 35 years the notices for ERISA rights to appeal were written on almost every EOB (Explanation of Benefits) in the daily practice in doctors' offices and hospitals, the healthcare providers, managed-care third-party payers, and even legal professionals as well as the state regulators rarely understood how to conduct, manage or regulate ERISA claim appeals for ERISA claim denials and disputes.

 

There have been urgent and popular regulatory needs and market demands for ERISA claim compliance education and training in this $6 trillion healthcare denial management market.


 

Related links:

 

ERISAclaim.com: ERISA or non-ERISA Appeal? ERISA Appeal Fact Sheet

 

ERISAclaim.com - ERISA or PPO? Managed Care Slavery or ERISA Superhero

 

ERISAclaim.com - ERISA Appeals or Lawsuit with PPO Contract or Class-Action Settlement

 

ERISAclaim.com: ERISA or non-ERISA Appeal? ERISA Appeal Fact Sheet

 

 

ERISA & Claim Denials

Aetna Video Shows ERISA Patients Mistreated

 

"According to the video, when faced with claims for identical medical problems, Aetna separates the claims where no damages are available - those subject to the federal Employee Retirement Income Security Act, or ERISA - from non-ERISA claims, where consumers can sue.1 2"

 

ERISA & Health Claim
What Is ERISA and How Does It Affect Patient Rights?

 

"ERISA was enacted in 1974 to protect the pension and welfare benefits that employers provide their workers. It currently covers about 2.5 million health plans and 125 million workers, retirees, and dependents."

 

Department of Labor

 
"A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

Most private sector health plans are covered by the

 Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law."

 

 

$10,600 ERISA Claim

Recent Federal Court Ruling in a Case with $10,600 medical claim, insurance Co. refused to pay, provider made numerous demand for payment in almost one year, but no appeals filed, the court dismissed the lawsuit because provider failed to exhaust administrative remedy, as required under ERISA, by filing ERISAclaim appeals.  This situation is so popular in health-care community.

 

 

 

 

Agree to terms and conditions

"Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply."

 

CIGNA - Coverage Positions/Criteria
"The terms of a participant's particular benefit plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Positions are based. If these Coverage Positions are inconsistent with the terms of the member's specific benefit plan, then the terms of the member's specific benefit plan always control."

 

UnitedHealthcare Medical Policies

"By clicking "I agree," you agree to be bound by the terms and conditions expressed below, in addition to our Site Use Agreement.

UnitedHealthcare medical policies have been made available to you as a general reference resource. When reading these policies you agree that:

Our Medical Policy is not your patient's Benefit Plan.

Your patient's medical benefits are governed and determined by a benefit document, either a Certificate of Coverage or a Summary Plan Description. You should not rely on the information contained in this Web site section to determine your patient's medical benefits.
 

  1. Federal and state mandates and the patient’s benefit document take precedence over these policies.

  2. The patient’s benefit document lists the specific services that have coverage limits or exclusions.


Our Medical Policy does not address every situation and individuals should always consult their physician before making any decisions on medical care."

 

 

   
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Phone (630) 736-2974 - Fax (630) 736-1439

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