When the CAO determines that a budget group is eligible for MA Benefits, the CAO will review the need for ACCESS cards for each individual in the budget group. The CAO will review and issue cards as follows:
Individuals who previously received ACCESS cards - Review with the individual the need for cards and issue replacements, if needed.
An ACCESS card will automatically be issued to the following individuals:
New individuals not on CIS - CIS will automatically issue ACCESS cards when MA is authorized on CIS; and
Inactive individuals on CIS (no prior ACCESS authorization) - CIS will automatically issue ACCESS cards when MA is authorized on CIS.
The following codes are used to issue or replace ACCESS cards:
1—Not received.
2—Lost or Stolen.
3—Damaged card, not able to run in card reader (Magnetic stripe does not work).
4—Damaged card, by recipient or other (Folded, mutilated, etc.).
5—Social Security Number added or changed which results in a change to the client’s recipient individual number.
6—Name Change.
7—Other (Use if no other number explains situation. Explain in CIS/eCIS Case Comments).
8—Initial Card automatically issued by CIS/eCIS.
9—Initial Card Issuance.
10—Special 45 Day Eligibility.
The CAO will data enter the appropriate code on the CIS/eCIS CCIPAC screen.
Important: If an eligible individual has an immediate need for medical care or services, the CAO will issue a Temporary ACCESS Card in addition to the ACCESS card.
Each ACCESS card contains the following information:
Recipient Number: Nine digit CIS Individual Number and one digit validation number now used by medical providers and designated non-MA providers to identify individual eligibility. Medical providers use this number to bill the Department for medical services.
Name of individual as displayed on CIS Individual Inquiry Screen.
Card Issue Number: System assigned number to each card for security purposes. This number is randomly assigned and not in sequential order. The card issue number is voided when a replacement card is requested.
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 panel is tamper proof. Advise individuals not to erase the signature.
Warning Statement to Individual.
See Appendix A for a copy of the Pennsylvania ACCESS card and the card carrier which is used to mail the ACCESS card to an individual.
ACCESS cards are mailed through the US Postal Service. The CIS nightly batch process creates a tape file of all card requests for each day (CIS automated requests and CAO worker initiated replacements). The tape file is sent to the card contractor who has 48 hours from receipt of the tape file to produce and deliver the cards to the US Postal Service. The US Postal Service mails cards on the same day of delivery by the contractor to the post office.
NOTE: Direct Delivery of cash and/or SNAP benefits will not affect delivery of the ACCESS card.
An individual should receive the ACCESS card within seven calendar days of CIS/eCIS data entry completion for initial MA or card replacement.
A Temporary ACCESS Card (TAC) issued by the CAO is either mailed or picked up by the individual at the CAO and is valid for seven calendar days or until the ACCESS card is received. The TAC is valid for 30 days for GA TD-55 individuals.
The individual does not need a fixed residence, but must have a mailing address. If the individual has problems receiving mail, the CAO may be used as a mailing address. If the mailing address is not the individual’s residence, the CAO will record the residence address in the CIS Case Comments, explaining the reasons for the discrepancy.
NOTE: The CAO will not record the residence address of an individual who is living in a shelter for abused women and children.
The Post Office will not forward an ACCESS card if the individual is not at the address printed on the card carrier. A card which cannot be delivered is returned to Central Office. Central Office will void the card and forward it to the CAO.
Important: To ensure delivery of ACCESS cards for all budget group members, the CAO will inform individuals to notify the post office of all individuals living in the household.
ACCESS cards will be returned to the Central Office due to:
U.S. Post Office Return - These cards are destroyed by the Central Office. The Central Office perforates and writes “VOID” on the card’s envelope and returns the envelope to the CAO. The CAO is to review the case for correct address.
Lost Card Return - These cards are destroyed by the Central Office. The Central Office does not contact the CAO and does not forward lost cards to the CAO.
The CAO will determine the appropriate action to take for any cards that are returned to the CAO.
Each CAO will have a staff member designated to handle returned ACCESS cards. That person will dispose of the card as follows:
1. Maintain a list of returned cards if needed.
2. Record the reason for the return on the envelope and forward the envelope to worker for review and appropriate action.
3. Cut all cards in half and dispose of the card properly.
When an ACCESS card is returned to the CAO, the CAO will:
1. Review to determine if an address change has been reported. Review individual information on the card for correctness.
NOTE: It is the responsibility of the individual to inform the CAO of a change in address or circumstances. However, the CAO must ensure that medical benefits continue for eligible individuals who are hospitalized and unable to advise the CAO of their circumstances.
2. Change the address and/or individual information. Authorize a replacement card if the information that appears on the card has been changed (Example: name change). If a valid ACCESS card was returned to the CAO, return card to the individual.
3. If the budget group has not reported an address change or nonreceipt of cards, the CAO will:
Review CIS to ensure that the CAO has correctly data entered the information.
If CIS is correct, close the budget.
Provide a Confirming Notice advising of the budget close.
If the budget group contacts the CAO review the reasons for nonreceipt. Reinstate MA effective the date of suspension or close the budget, as appropriate.
ACCESS cards need to be returned to Harrisburg if they are replaced with the following issuance codes:
Code 3—Damaged card; not able to run card in card reader due to a defective magnetic stripe.
Code 4—Damaged card by recipient or other (folded, mutilated, etc.).
These cards will be examined to ensure the card contractor is upholding card production standards.
The CAO will handle damaged cards as follows:
1. Ask the individual to explain the card damage if the card is not visibly damaged (folded, print not readable, edges bent, etc.).
NOTE: It is important to identify cards with a defective magnetic stripe. Only cards identified with a defective magnetic stripe are replaced on CIS using code 3.
2. Issue a replacement card.
3. Complete a PW 764, attach the damaged card to the form and forward to the designated staff member in the CAO who handles damaged ACCESS cards.
A function of the CAO is to identify individuals who abuse or defraud the MA Benefits Program. A provider may notify the CAO that an individual is abusing their MA services or defrauding the MA program. 55 Pa. Code § 1101.91(a)
Individuals who have been determined to be abusing, misusing, or defrauding the MA Benefits Program may have restrictions placed on their ACCESS card. The Office of Medical Assistance Programs (OMAP) completes the restriction process. The process involves an evaluation of the degree of abuse, a determination if the individual should be restricted, notification of the restriction, and the evaluation of subsequent MA services.
The individual will receive a notice from OMAP (Appendix B) informing the individual of the restrictions placed on their ACCESS card. The CAO will receive a copy of the letter to be filed in the individual’s case record. 55 Pa. Code § 1101.91(b)
If an individual reports that the ACCESS card is not working the CAO can inquire through CIS to confirm if there is a restriction placed on the card.
1. The CAO will access the CQBMEM screen of the case to review the Lock-In indicator field (LK).
2. The LK field will show either:
N—None.
Y—Yes, restriction(s) exist.
The CAO can obtain further details of the restriction(s) placed on the ACCESS card by accessing the PROMISe system:
1. Login to PROMISe.
2. Enter the Individual’s Recipient Identification Number (RID).
3. Click the Lock tab on the right side of the page.
4. Restricted provider or pharmacy will be displayed on the screen.
Updated February 14, 2012, Replacing March 3, 2011