1. hb```b``Vg`a`PSdd@ Af(00k``` FP1`ecbeIcIaYraT56V @ig`qF"Le> g7 All Rights Reserved to AMA. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. 0000020458 00000 n <. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. Medicare denial codes, reason, action and Medical billing appeal Monday, June 20, 2011 Remark code - N357, M119, M123, M2, M50, M54 & N129, N130, N19 Denial Code 45, 50, 54,58, 59, 60, 96, 97 and related remark codes N19 - Procedure code incidental to primary procedure. 3. Description (if applicable) Service line is submitted with a $0 Line Item Charge Amount. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. This initial check will reduce half of your claim denials as well as help you to save time and money. Am. Am*Z13@eg` 4/S! CMS Disclaimer IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. 0000066408 00000 n 0000004514 00000 n %PDF-1.4 % You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Here we have list some of th Medicaid Claim Denial Codes 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent w MCR - 835 Denial Code List CO : Contractual Obligations - Denial based on the contract and as per the fee schedule amount. You acknowledge that the AMA holds all copyright, trademark, and other rights in CPT. endstream endobj 1077 0 obj <>stream We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. H|Tr LA/KiZ]&b&c$L>H$hy#XdOT-Ab6#z-xp3P\8~O;+RHUTSRK6PiK}CT!4cOm\*&i=w#V0SE%l+{Btnws*g@ &@",U Remittance Advice Remark Codes (RARCs) Enclosure 1. HTr0+LP$6BIIkl~8nSqslYViWzi4SUe]2jY>8q)nP@Oi24*d uwFl#ZVcZ+zlt#b%ZGgG7xD+jL14%X'gzJE8pz84BY`5 }I7l r2;tX Any questions pertaining to the license or use of the CDT should be addressed to the ADA. In addition, this update contains the Optum claim codes and reasons. %%EOF The scope of this license is determined by the ADA, the copyright holder. 0000004668 00000 n N130 Consult plan benefit documents for information about restrictions for this service RARC N130 will be used with CARC 96 as a default combination to be reported on all DME claims if: No code has been assigned by your Medicare contractor, and The service is not covered by Medicare A development letter requesting additional documentation to support service billed was not received within the provided timeline. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. Code. Not paid separately when the patient is an inpatient. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Multiple physicians/assistants are not covered in this case. hTP=O0+!RtC%nDM{}|#@s=&=9%l.8yml"L%i%7tnAC4e^~e_c)_ +k%lhBhzxle;^x2gjXZ + j hbbd```b``A$Dbf{`f` 2WH2n bOy$F4H5?# z9 BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. AMA Disclaimer of Warranties and Liabilities hbbd```b``"I=0"UQ`r?X "Y~vL,` D.Al P=#?~ @ The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. 0000001885 00000 n )^62;{Rt!v. bHo{~s: Xo1~,om:5(4K0ni\2%[%S9 This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. HrsS iO!o&$Mx94luSYT*-GX#vA=/&#Bhr,_h#1w AiW ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Short-Doyle / Medi-Cal Claim Payment/Advice (835) . endstream endobj 526 0 obj <>stream Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Start: 06/01/2008. Warning: you are accessing an information system that may be a U.S. Government information system. This system is provided for Government authorized use only. Optum Alaska Claim Codes Claim Adjustment Reason Codes (CARC) Codes Remittance Advice Remark Coding (RARC) Codes Still, have any doubts? 0000017783 00000 n &-#&^i #&s!W`t(5 0000015727 00000 n There are times in which the various content contributor primary resources are not synchronized or updated on the same time interval. 0000004340 00000 n 0000001683 00000 n If you feel some of our contents are misused please mail us at medicalbilling4u at gmail.com. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. 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. p.sc,kGi03 The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Reproduced with permission. Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. M32 MA44 N130 N185 N364 M39 MA45 N132 N187 N367 M70 MA59 N133 N189 M118 MA62 N134 N196 MA01 MA68 N136 N202 MA07 MA72 N137 N210 MA08 MA77 N138 . &i$5?aRv NhAnx/V/wL\\Qf {D`c$,Dy:Czf3Fb.MaINL#/#ee[Kg=H^LSGj?>os.tIG9++ 3L+K^_ys;lmC>X^. Not covered unless a pre-requisite procedure/service has been provided. FOURTH EDITION. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place. Denial Codes: Description: CARC: RARC: 2 Charge exceeds the maximum allowable under member's coverage. PR 2 - Coinsurance once the annual deductible is reached, the insurance company will begin to pay a portion of all covered costs. Each RARC identifies a specific message as shown in the Remittance Advice Remark Code List. ycZgIkM-jaU ^FRk'YsbD)/\JQI&av~`DRTF:y4iPFFc_J(y20| q{J+%cDa0_ B>C6e-Y)K@h8-m=&([^ This Agreement will terminate upon notice to you if you violate the terms of this Agreement. endstream endobj startxref Moreover, different payers have different medical necessity criteria. Receive Medicare's "Latest Updates" each week. We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package. hb```b````a`4ge@ ^rt MGNZsw%Dwm\q4, PC+PN_bbF 8Cdcy} +RD '>Ck10i W8 M * For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. Missing/incomplete/invalid principal procedure code. 0000021903 00000 n Contractors may pick one of those newly . endstream endobj startxref ;JWrT*@SlouHH{q*9]Wy&y5|Mo7Y!l-r7/F7EY[;ofO['o.bSP0A.XbqN|PskBV_Wm<8oOP|!!\c0$eP%Sdd&!()uI{tz6})H)m.({2-5QNi9'.N9QN&=BEg;n,(U,.{(?!X: ";oP$e$"}Xzg#i + + You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. End users do not act for or on behalf of the CMS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. */BmFA 0000036838 00000 n Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. The qualifying other service/procedure has not been received/adjudicated. Missing/incomplete/invalid revenue code(s). 0000000016 00000 n This service/procedure requires that a qualifying service/procedure be received and covered. endstream 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. >ZYg'q. 2+=OAd!5((:xKLVe"V1OVF endstream endobj 2454 0 obj <>stream The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. PR 1 - Deductible - the amount you pay out of pocket. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. endstream endobj 1078 0 obj <>stream Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. CO/26/- and CO/200/- CO/26/N30 : Late claim denial. <>/Filter/FlateDecode/ID[<70B8A8E963B2B2110A000082925CFD7F>]/Index[1134 30]/Info 1133 0 R/Length 99/Prev 139356/Root 1135 0 R/Size 1164/Type/XRef/W[1 3 1]>>stream To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. 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. is a non-covered, restricted, reporting only or bundled Procedure code or Service: 96: N130: P10: The place of Service code is missing or invalid for the Procedure code: 16: M77: P11: Now, you know about denial code CO 50 and what to do if it occurs. 0000066367 00000 n These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). All rights reserved. The committee that maintains the reason codes has approved a new reason code 204 ("This service/equipment/drug is not covered under the patient's current benefit plan") that became effective on 2/28/07. if(pathArray[4]){document.getElementById("usprov").href="/web/"+pathArray[4]+"/help/us-government-rights";} 0 Denial Code 45, 50, 54,58, 59, 60, 96, 97 and related remark codes. Missing/incomplete/invalid other procedure code(s). Please click here to see all U.S. Government Rights Provisions. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) q?OSLE"-,aiSo3+>>LH /9 But the 'PR' in the denial indicates that the payer has determined that the patient is responsible for the charges. The scope of this license is determined by the AMA, the copyright holder. 0000023586 00000 n Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Medicare contractors must update their remittance advice maps/matrices as appropriate to incorporate those Related CR Release Date: August 6, 2010 . 8`|G y30Hn~$"V r[ 20oXlwxp0%0^a`pmQ)#gh q$>f6R\@-@Ju9D1 @ _3,? PR - Patient Responsibility Adjustments. 2 0 obj CO/204/N206. Service not payable with other service rendered on the same date. 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. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, Last Updated Mon, 11 Jan 2021 15:33:02 +0000. 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. These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). 0 You may also contact AHA at ub04@healthforum.com. 0000011854 00000 n ]sUay=>8yyu696vnwNd*G`da9:>uWT$8ro DC'-miJw =;W? To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. These are non-covered services because this is not deemed a `medical necessity' by the payer. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication or data transiting or stored on this system. Remark Code: N130. %PDF-1.4 % 0000013718 00000 n The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. Page 4 of 7. hb```," Not covered unless a pre-requisite procedure/service has been provided. Are you looking for more than one billing quotes? 0000018716 00000 n Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. The simple meaning for the above sentence is, you should educate your patient regarding the treatments. j ENj 0000033653 00000 n 224. What is the Medicare denial code for Ma? CO-N130: Consult plan benefit documents/guidelines for information about restrictions for this service CPT code: 99397 (Status "N" on MPFSDB) Resolution and Resources Routine physical exams are never covered by Medicare except under the "welcome to Medicare physical" or "initial preventive physical exam" (IPPE) guidelines. 0000019906 00000 n HWko_1@*,G#{(hj$MrH{{_A23E& var url = document.URL; 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. Am. Rejection code 34538, 36428, 39929,76474, c7010 - solution, PR - Patient Responsibility denial code list, CO : Contractual Obligations denial code list, Medicare denial codes - OA : Other adjustments, CARC and RARC list, what is WO - withholding and FB - Forward balance with exapmple, Provider-level adjustments basics - FB, WO, withholding, Internal Revenue service, Venipuncture CPT codes - 36415, 36416, G0471, CPT 80053, Comprehensive metabolic panel, Inappropriate or invalid place of service - Action on Denial. Item billed may require a specific diagnosis or modifier code based on relatedLCD. According to a CMS, It is observed that 30% of claims are either denied, lost, or ignored. The ADA does not directly or indirectly practice medicine or dispense dental services. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. endstream endobj 2451 0 obj <>/Metadata 67 0 R/Outlines 103 0 R/PageLabels 2444 0 R/PageLayout/OneColumn/Pages 2446 0 R/PieceInfo<>>>/StructTreeRoot 115 0 R/Type/Catalog>> endobj 2452 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 2453 0 obj <>stream To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. Select the Reason or Remark code link below to review supplier solutions to the denial and/or how to avoid the same denial in the future. %%EOF endstream endobj 525 0 obj <>stream 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. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. endstream endobj 1072 0 obj <>/Metadata 36 0 R/Pages 1069 0 R/StructTreeRoot 79 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1073 0 obj <>/MediaBox[0 0 612 792]/Parent 1069 0 R/Resources<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1074 0 obj <>stream 1076 43 LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) 5. hVmo6+&;MP$2,jEIv/pw9R CO, PR and OA denial reason codes codes. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, Last Updated Tue, 20 Sep 2022 20:12:33 +0000. %PDF-1.4 % AMA Disclaimer of Warranties and Liabilities License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. endstream Reproduced with permission. S01) tWR@`B9i!0x~=gQ,ZWU$b#,m3GehpKr;0|s$ The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes. You should understand that the medical necessity policy of each payer varies greatly as well as it is continuously changing. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. 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. %PDF-1.5 If you choose not to accept the agreement, you will return to the Noridian Medicare home page. (For example multiple surgery or diagnostic imaging, concurrent anesthesia). 2. endstream endobj startxref It is necessary to note here though Medicare and the American Medical Association (AMA) are the foundation of the guidelines, each state separately has guidelines for medical necessity. This license will terminate upon notice to you if you violate the terms of this license. 0 Denial Code CO 50 means that the payer refused to pay the claim because they did not deem the service or procedure as medically necessary. }{@-" Hox-rmMByX;}Gio}mzSN!g}uN$'~p-9 #n_P7dG9ZDGd%zEdJe2;62L;pO?5^J]JHNDOmO mN!%!JLXUaF No fee schedules, basic unit, relative values or related listings are included in CDT. BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. 4QY_elOiuC'E8-a5NJC$Ia`M1 9,G?/",".Ky3h3>(/~J]IGiR?6'x`SW?,}r0a&ZJ1zZx:Ha@ob`W/r.vLY8$yGq0mv2{;O{V k>_N #]:J]fQ&,3N4w;{hmkuRS{L]6pk5p.#P9{15q._mZw2-Mim>:N6k{xoK{mw74:p6sa%b]aQ;bn u&~` x\67-pq% The qualifying other service/procedure has not been received/adjudicated. 2462 0 obj <>/Filter/FlateDecode/ID[<0A9BDEC6E6943BD958E55AF37E529040>]/Index[2450 21]/Info 2449 0 R/Length 68/Prev 101280/Root 2451 0 R/Size 2471/Type/XRef/W[1 2 1]>>stream Based on insurance contracts held by a practice, medical necessity denial may require a practice to perform various series of tasks. hA 04u\GczC. 0000044140 00000 n The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. endobj End users do not act for or on behalf of the CMS. The Centers for Medicare & Medicaid Services (CMS) is the national maintainer of the remittance advice remark code list. Your front office staff should be checking insurance coverage for patients and authorization for office visits and procedures. else{document.getElementById("usprov").href="/web/"+"jeb"+"/help/us-government-rights";}, Advance Beneficiary Notice of Noncoverage (ABN), Oral Anticancer Drugs and Oral Antiemetic Drugs, Transcutaneous Electrical Nerve Stimulators (TENS), Supplemental Medical Review Contractor (SMRC), Unified Program Integrity Contractor (UPIC), Provider Outreach and Education Advisory Group (POE AG), Healthcare Integrated General Ledger Accounting System (HIGLAS), Physician or Other Treating Practitioner, Physical Therapist, or Occupational Therapist, click here to see all U.S. Government Rights Provisions, American Hospital Association Online Store. hmo8SKbVHJtPTJh!AIV-fBRe{&H/ DJFx }(KFP*1>Qf(|qWC AVDMOtYzpa0OATs::Ng38p/`+t)G?4K6Y8/3:vt=#s#g\uT 8N'mw2$EI&BnN 1ID03%x@p8Jg2(GhlVOFN$jG zF Having a knowledgeable and skilled coding team on payer policies, contracts, local coverage determination (LCD), and national coverage determination (NCD) codes, with detailed documentation from the clinical team who communicate effectively will enhance the prevention of denials. To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. Reason Code 204 | Remark Code N130 Common Reasons for Denial This is a noncovered item Item is not medically necessary Next Step A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages, Review applicable Non-Contract Suppliers and Exceptions under the tips section of the, The OTS back brace or OTS knee brace must be furnished by the non-contract physician or other treating practitioner to his or her own patient as part of his or her professional service, Must be office visit, surgery is not included, Must be medically necessary and applied for use prior to surgery, Claims must have the same date of service as the professional office visit or physical/occupational therapy service that is billed to the Part B MAC. This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. This system is provided for Government authorized use only. 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. 0000007137 00000 n AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA.
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