Appendix A: Sample ACCESS Card (MA)

Description Of ACCESS Card

The ACCESS card is a standard size plastic card with a yellow background and blue lettering.

ACCESS	Name of card and Keystone logo.
RECIP#	Nine-digit CIS Individual Number and one-digit validation number now used by medical providers and other authorized providers such as MA Transportation providers to identify client eligibility and to bill the Department for services.
NAME:	Name of individual as displayed on CIS Individual Inquiry Screen.
CARD ISSUE #	Number assigned to each card for security purposes by the Eligibility Verification System (EVS). This number is randomly assigned and not in sequential order. The card issue number is voided by issuance of a replacement card.

NOTE: Medical providers receive message "Client not eligible" when a voided ACCESS card is used. Remind clients to destroy voided cards.

MAGNETIC STRIPE	Coding stripe that contains information used by point of sale (POS) devices to identify eligibility for medical benefits.
SIGNATURE PANEL	The blue signature stripe is tamper proof. Clients should not erase signature. Clients should sign card for their own protection. Clients age 18 or over, or under 18 and head of household should sign card. Children may sign if they wish.
MISUSE OR ABUSE OF THIS CARD MAY MAKE YOU LIABLE FOR CIVIL ACTION AND/OR CRIMINAL PROSECUTION	Warning statement to individual.
1-800-932-0582	Fraud and Abuse Hotline.
RETURN ADDRESS Department of Public Welfare Harrisburg, PA 17105	This address is for the general public to return lost cards to Harrisburg. The address is not for providers, clients, or CAO staff to return cards and other mail to Harrisburg. Regular reporting procedures are use to return mail and to report changes.

Updated February 14, 2012, Replacing September 17, 2010