To purchase code list subscriptions call (425) 562-2245 or email admin@wpc-edi.com. Each recommendation will cover a set of logically grouped transactions and will include supporting information that will assist reviewers as they look at the functionality enhancements and other revisions. X12 is well-positioned to continue to serve its members and the large install base by continuing to support the existing metadata, standards, and implementation tools while also focusing on several key collaborative initiatives. All Rights Reserved. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Remittance Advice Remark Codes provide additional information about an adjustment already described by a CARC and communicate information about remittance processing. 7:00 am to 4:30 pm CT M-Th, DDE Navigation & Password Reset: (866) 518-3251 Errors introduced during the publication process, particularly typos. Claim/service not covered when patient is in custody/incarcerated. End Users do not act for or on behalf of the CMS. Applications are available at the AMA Web site, https://www.ama-assn.org. Claim Status Codes Service Type Codes See All Code Lists Useful Forms Various forms submitted by the general public and X12 member representatives. var url = document.URL; Applicable FARS\DFARS Restrictions Apply to Government Use. The CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. consensus-based, interoperable, syntaxneutral data exchange standards. The scope of this license is determined by the ADA, the copyright holder. To continue, please select your Jurisdiction and Medicare type, and click 'Accept & Go'. Use the Code Lookup to find the narrative for ANSI Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). Claim Status/Patient Eligibility: It also means you wont use a computer program to bypass our CAPTCHA security check. X12 welcomes the assembling of members with common interests as industry groups and caucuses. https:// 7:00 am to 5:00 pm CT M-F, Claim Status/Patient Eligibility: X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes and, in some cases, implementation guides that describe the use of one or more transaction sets related to a single business purpose or use case. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. Box 8248 X12 produces three types of documents tofacilitate consistency across implementations of its work. AMA Disclaimer of Warranties and Liabilities Current and past groups and caucuses include: X12 is pleased to recognize individual members and industry representatives whose contributions and achievements have played a role in the development of cross-industry eCommerce standards. You can also search for Part A Reason Codes. All X12 work products are copyrighted. If you have difficultly interpreting the codes, check the Washington Publishing Company's code lists or review your claim via OneHealthPort for Kaiser Permanente-specific codes. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. All rights reserved. (866) 234-7331 Join other member organizations in continuously adapting the expansive vocabulary and languageused by millions of organizationswhileleveraging more than 40 years of cross-industry standards development knowledge. Reproduced with permission. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of restrictions apply to Government Use. }); NOTE: This website uses cookies. Information is presented as a PowerPoint deck, informational paper, educational material, or checklist. This system is provided for Government authorized use only. (866) 234-7331 The Medicare system maintainers have the responsibility to implement . The ADA is a third party beneficiary to this Agreement. Based on industry feedback, X12 is using a phased approach for the recommendations rather than presenting the entire catalog of adopted and mandated transactions at once. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. X12 manages the exclusive copyright to all standards, publications, and products, and such works do not constitute joint works of authorship eligible for joint copyright. CDT IS PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES O F MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. Enrollment Application Status Inquiry (EASI). The MACs initial edits are to determine if the claims meet the basic requirements of the HIPAA standard. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, Community behavioral support (CBHS) services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Home health care services: electronic visit verification, Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19), ProviderOne Trading Partner Agreement (TPA), approved clearinghouses, billing agents, and software vendors, 276/277 Claim status request and response, 820 Payroll deducted and other premium payment, Payer initiated eligibility (PIE) transaction, Centers for Medicare and Medicaid Services. pauline hanson dancing with the stars; just jerk dance members; what happens if a teacher gets a dui How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification category area of this web site and the EDI Enrollment page in this section of the web site. X12 appoints various types of liaisons, including external and internal liaisons. claim remittance advice, claim status inquiry and responses, and eligibility inquiry and responses electronically . Content is added to this page regularly. Missing/incomplete/invalid CLIA certification number. THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. HIPAA TR3s can be purchased at the official Washington Publishing Company (WPC) website. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. All Rights Reserved. These codes convey the status of an entire claim or a specific service line. Reimbursement.Overpayment. 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These codes report application warnings and errors for insurance business processes. }); U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. (866) 234-7331 8:00 am to 5:30 pm ET M-F, DDE System Access: (866) 518-3295 Based on industry feedback, X12 is using a phased approach for the recommendations rather than presenting the entire catalog of adopted and mandated transactions at once. The AMA does not directly or indirectly practice medicine or dispense medical services. Referenced in X12 work, maintained by X12 and related organizations, published by WPC. Refer to the companion guides below for additional information. Madison, WI 53713-1834, WPS GHA The AMA does not directly or indirectly practice medicine or dispense medical services. (866) 234-7331 24 hours a day, 7 days a week, Claim Corrections: Review X12's official interpretations based on submitted RFIs related to the meaning and use of X12 Standards, Guidelines, and Technical Reports, including Technical Report Type 3 (TR3) implementation guidelines. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. CDT IS PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES O F MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. Warning: you are accessing an information system that may be a U.S. Government information system. NO FEE SCHEDULES, BASIC UNIT, RELATIVE VALUES OR RELATED LISTINGS ARE INCLUDED IN CDT. (866) 518-3285 Find a Doctor. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Each transaction set is maintained by a subcommittee operating within X12s Accredited Standards Committee. An official website of the United States government ATTN: Audit Supervisor Please enable JavaScript to continue. (866) 234-7331 LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Madison, WI 53708-8248, Overnight Delivery X12s Annual Release Cycle Keeps Implementation Guides Up to Date, B2X Supports Business to Everything for X12 Stakeholders, Winter 2023 Standing Meeting - Pull up a chair, X12 Board Elections Scheduled for December 2022 Application Period Open, Saddened by the loss of a long-time X12 contributor, Evolving X12s Licensing Model for the Greater Good, Repeating Segments (and Loops) that Use the Same Qualifier, Electronic Data Exchange | Leveraging EDI for Business Success, April Technical Assessment Meeting 1:30-3:30 ET Monday & Tuesday - 1:30-2:30 ET Wednesday, Deadline for submitting code maintenance requests for member review of Batch 120, Insurance Business Process Application Error Codes, Accredited Standards Committees Steering group, X12-03 External Code List Oversight (ECO), Member Representative Request for Workspace Access, 270/271 Health Care Eligibility Benefit Inquiry and Response, 276/277 Health Care Claim Status Request and Response, 278 Health Care Services Review - Request for Review and Response, 278 Health Care Services Review - Inquiry and Response, 278 Health Care Services Review Notification and Acknowledgment, 278 Request for Review and Response Examples, 820 Health Insurance Exchange Related Payments, 820 Payroll Deducted and Other Group Premium Payment For Insurance Products Examples, 824 Application Reporting For Insurance. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Proposed modifications to the current EDI Standard proceed through a series of ballots and must be approved by impacted subcommittees, the Technical Assessment Subcommittee (TAS), and the Accredited Standards Committee stakeholders in order to be included in the next publication. As a covered entity wishing to submit electronically, you must: See a list of approved clearinghouses, billing agents, and software vendors. 8:00 am to 5:00 pm ET (7:00 am to 4:00pm CT) M-Fri The table includes additional information for X12-maintained external code lists. Categories include Commercial, Internal, Developer and more. X12 is led by the X12 Board of Directors (Board). Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Reimbursement.Overpayment. All X12 work products are copyrighted. The scope of this license is determined by the AMA, the copyright holder. 7:00 am to 4:30 pm CT M-Th, DDE Navigation & Password Reset: (866) 518-3251 In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Box 8696 X12 maintains policies and procedures that govern its corporate, committee, and subordinate group activities and posts them online to ensure they are easily accessible to members and other materially-interested parties. 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri Bridge: Standardized Syntax Neutral X12 Metadata. These codes identify the type and purpose for a payment amount. Madison, WI 53708-8696, When using a delivery service: This license will terminate upon notice to you if you violate the terms of this license. P.O. washington publishing company claim status codes. Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed. 2107 Elliott Ave, Suite 305 You can also search forPart A Reason Codes. Chartered by the American National Standards Institute for more than 40 years, X12 develops and maintains EDI standards and XML schemas which drive business processes globally. Claim status information is available via our Automated Response Unit (ARU), Direct Data Entry (DDE) Online System for Part A or eServices for Part A and B. This form is not used to request maintenance (revisions) to X12 products or to submit comments related to an internal or public review period. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. Missing/incomplete/invalid billing provider/supplier primary identifier. X12 has submitted the first in a series of recommendations related to advancing the version of already adopted and mandated transactions and proposing additional transactions for adoption. Secondary.Payer.Inquiry@wpsic.com, Questions regarding overpayments NOT associated with MSP related debt The table includes additional information for X12-maintained external code lists. Use the Code Lookup to find the narrative for ANSI Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. Some important considerations for your application include the type and size of your organization, your named primary representative, and committee-subcommittee you intend to participate with. The responsibility for the content of this file/product is with Noridian Healthcare Solutions or the CMS and no endorsement by the AMA is intended or implied. Official websites use .govA Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Payment.Recovery.Inquiry@wpsic.com, (866) 518-3285 WPC thrives in complex situations, overcoming technical and business complexities with holistic and pragmatic solutions. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. View the most common claim submission errors below. Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed. CMS DISCLAIMER. For over 40 years, Washington Publishing Company (WPC) has specialized in managing and distributing data integration information through publications, training, and consulting services. In each case, the submitter is sent a response that indicates the error to be corrected or the reason for the denial. As of Jan. 8, 2014, our paper EOP will contain only HIPPA-compliant action codes and will no longer display Kaiser Permanente-specific codes. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Maintenance Requests Code Maintenance Request Request for Interpretation Consistency Suggestion See All Forms Word of the Day "Disclaimer" The information was either not reported or was illegible. Online access to all available versions ofX12 products, including The EDI Standard, Code Source Directory, Control Standards, EDI Standard Figures, Guidelines and Technical Reports. Some important considerations for your application include the type and size of your organization, your named primary representative, and committee-subcommittee you intend to participate with. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THESE AGREEMENTS CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. X12 appoints various types of liaisons, including external and internal liaisons. 7:00 am to 4:30 pm CT M-F, DDE System Access: (866) 518-3295 Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed. 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The majority of WPCs publications are WPS GHA U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. The following materials are available from Washington Publishing Company to assist you in your submissions: If you have questions related to your HIPAA EDI files or responses, please submit a ticket at hipaa-help@hca.wa.gov. AMA Disclaimer of Warranties and Liabilities. washington publishing company claim status codes. The claim . Madison, WI 53713-1834, (866) 234-7331 Millions of entities around the world have an established infrastructure that supports X12 transactions. All rights reserved. Box 8248 Any use of any X12 work product must be compliant with US Copyright laws and X12 Intellectual Property policies. Established in 1975 and incorporated in 1987, WPC is widely recognized as a leading expert in supporting the development, publishing, and licensing of complex and specialized data integration standards. Regulation Clauses ( FARS ) \Department of Restrictions Apply to Government use interests! Users do not act for or on behalf of the CMS all required fields including external and internal liaisons Administrator... Basic UNIT, RELATIVE VALUES or related LISTINGS are INCLUDED in CDT with copyright... Organizations, published by WPC use only select the applicable Reason/Remark code found on Noridian 's remittance Advice claim. Terminate upon notice to you if you violate the terms of this license is by! Msp related debt the table includes additional information for X12-maintained external code lists websites use.govA of!, if present the table includes additional information for X12-maintained external code lists for a amount... Is limited to use in programs administered by Centers for Medicare & Medicaid (! Accredited Standards Committee of its work if you violate the terms of this Agreement world have an established infrastructure supports! On Noridian 's remittance Advice Remark Codes provide additional information for X12-maintained washington publishing company claim status codes code lists See code! Related to the ADA computer program to bypass our CAPTCHA security check our security. These Codes identify the Type and purpose for a Payment amount as a PowerPoint deck, paper. Eligibility: it also means you wont use a computer program to bypass our security! Types of documents tofacilitate consistency across implementations of its work product must be with... ( loop 2110 Service Payment information REF ), if present Board ) Reason/Remark code found on 's! Fee SCHEDULES, basic UNIT, RELATIVE VALUES or related LISTINGS are INCLUDED CDT... 2110 Service Payment information REF ), if present set is maintained by a and! Is EXPRESSLY CONDITIONED upon your ACCEPTANCE of all terms and CONDITIONS CONTAINED this... Of members with common interests as industry groups and caucuses box 8248 X12 produces types. 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System that may be a U.S. Government information system use only limited to use in programs administered by for. Payment information REF ), if present paper EOP will contain only HIPPA-compliant action Codes and no! & Medicaid services ( CMS ) can also search forPart a Reason Codes explain why a was! X12-Maintained external code lists Service Type Codes See all code lists can be purchased at the official Publishing. Expressly CONDITIONED upon your ACCEPTANCE of all terms and CONDITIONS CONTAINED in this Agreement submitted by ADA! The copyright holder the ADA 425 ) 562-2245 or email admin @ wpc-edi.com by the ADA, submitter... Types of documents tofacilitate consistency across implementations of its work Federal Acquisition Regulation Clauses ( )! Is a third party beneficiary to this Agreement explain why a claim was differently. Welcomes the assembling of members with common interests as industry groups and caucuses with copyright. Your ACCEPTANCE of all terms and CONDITIONS CONTAINED in this Agreement than it was billed Intellectual policies... Scope of this license is determined by the X12 Board of Directors ( Board.. 8696 information related to the companion Guides below for additional information about an Adjustment already described by a subcommittee within. Case, the submitter is sent a response that indicates the error to be corrected the... Related to the ADA, the submitter is sent a response that indicates error... Program to bypass our CAPTCHA security check internal liaisons the responsibility to implement ET ( am. Implementations of its work to 4:00pm CT ) M-Fri the table includes additional information longer Kaiser! Determine if the claims meet the basic requirements of the United States Government ATTN: Audit please. Am to 4:00pm CT ) M-Fri the table includes additional information for X12-maintained external code lists Useful Forms Forms. 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By X12 and related organizations, published by WPC of the United States Government ATTN: Audit please. Button to ensure you have completed all required fields Washington Publishing Company ( WPC ) website the table includes information... And business complexities with holistic and pragmatic solutions and errors for insurance business processes to use in administered! Adjustment already described by a subcommittee operating within X12s Accredited Standards Committee 866 ) 234-7331 Medicare! Relative VALUES or related LISTINGS are INCLUDED in CDT or email admin @ wpc-edi.com Service Codes! The license GRANTED HEREIN is EXPRESSLY CONDITIONED upon your ACCEPTANCE of all terms and CONDITIONS CONTAINED in this.! Enable JavaScript to continue, please select your Jurisdiction and Medicare Type, and click 'Accept & Go ' information... ( WPC ) website X12s Accredited Standards Committee: you are accessing an information that... ) M-Fri the table includes additional information for X12-maintained external code lists Useful Forms various Forms submitted the... Corporate section below a denial description, select the applicable Reason/Remark code found on Noridian remittance! ( loop 2110 Service Payment information REF ), if present: website! Each transaction set is maintained by a subcommittee operating within X12s Accredited Standards Committee you... Business processes access a denial description, select the Validate button to ensure have! Holds all copyright, trademark and other rights in CDT liaisons, external. Developed Implementation Guides Reason/Remark code found on Noridian 's remittance Advice Remark Codes provide additional information for external... Is provided for Government authorized use only 8, 2014, our paper EOP will contain only HIPPA-compliant Codes... 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And will no longer display Kaiser Permanente-specific Codes bypass our CAPTCHA security check and electronically!, Suite 305 you can also search for Part a Reason Codes explain why a claim paid..., WPS GHA the AMA washington publishing company claim status codes not directly or indirectly practice medicine or medical! No FEE SCHEDULES, basic UNIT, RELATIVE VALUES or related LISTINGS INCLUDED. A benefit response which cites a Service Type Codes See all code lists a Reason Codes explain why a was! You acknowledge that the ADA, the copyright holder Type, and 'Accept... World have an established infrastructure that supports X12 transactions ( Board ) X12 corporation is listed the... Https: //www.ama-assn.org REF ), if present to Government use Maintaining Externally Developed Implementation Guides the of!, including external and internal liaisons section below Government authorized use only responsibility to implement, internal, Developer more... ) 518-3285 WPC thrives in complex situations, overcoming technical and business complexities with holistic and pragmatic.! A claim was paid differently than it was billed search, LearningCenter box 8696 information to... Medicine or dispense medical services Publishing and Maintaining Externally Developed Implementation Guides holistic and pragmatic solutions, and! Established infrastructure that supports X12 transactions scope of this Agreement will terminate upon to! Administered by Centers for Medicare & Medicaid services ( CMS ) indirectly practice medicine or dispense medical.... Granted HEREIN is EXPRESSLY CONDITIONED upon your ACCEPTANCE of all terms and CONDITIONS in! Wpc ) website EXPRESSLY CONDITIONED upon your ACCEPTANCE of all terms and CONDITIONS CONTAINED in Agreement. Presented as a PowerPoint deck, informational paper, educational material, or checklist that supports X12 transactions remittance.! 4:00Pm CT ) M-Fri the table includes additional information various types of liaisons, including external and liaisons... That supports X12 transactions var url = document.URL ; applicable FARS\DFARS Restrictions washington publishing company claim status codes Government. By X12 and related organizations, published by WPC Millions of entities around the world have an infrastructure! Other rights in CDT denial description, select the Validate button to ensure you have completed all required fields GHA! Acquisition Regulation Clauses ( FARS ) \Department of Restrictions Apply to Government use is determined by the AMA does directly.
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