PRISM at a Glance

PRISM, Provider Reimbursement Information System for Medicaid, is the name of the multi-year project to replace the current Medicaid Management Information System (MMIS). The contract was awarded to CNSI to work with Medicaid PRISM staff to develop the new system. The term “Release” is used for each component of software placed into production. There are four defined releases. 

Release 1: This release included updates to the website to facilitate distribution of Medicaid program information, along with a tool for providers to determine Medicaid member eligibility.  The release was completed in March 2014.

Release 2: The HealthBeat dashboard, implemented in August 2014, tracks progress toward health program goals and operational performance. The HealthBeat dashboard is an internal tool used by Division of Medicaid and Health Financing staff to access and monitor meaningful data.

Release 3: Provider Enrollment allows new providers to enroll electronically in the Medicaid system and gives current providers an opportunity to begin using the PRISM system.  Electronic Medicaid Incentive Payment Program (eMIPP) is the online PRISM software tool that will facilitate Medicaid providers’ adoption of electronic health record systems.  This release is live as of July 1, 2016.

Release 4: The final PRISM release replaces the current system and includes all remaining PRISM system functionality, including Medicaid Managed Care System (MMCS), claims adjudication, and claims payment. Additionally, this release includes Audit Studio, which will apply new patterns for fraud and abuse detection. The projected release implementation date is late 2019.