PRISM at a Glance

Printer-friendly versionPrinter-friendly version

PRISM, Provider Reimbursement Information System for Medicaid, is the name of the new Medicaid Management Information System (MMIS) and to fully transition to the new PRISM system will take several years.

There are three main components to PRISM, which are described below. The Provider Enrollment component is already implemented and some providers have been using it since July 2016.  Updates and changes to this component of PRISM will be coming in March 2020. The other two components are Core MMIS and Fraud and Abuse.

Components of PRISM

Provider Enrollment Updates. In July 2016 the initial Provider Enrollment component was implemented and is currently being used by providers. Changes to this component will be coming in March 2020.

Prior to the go-live date in 2020, Medicaid providers’ enrollment records will be migrated to the updated PRISM Provider Enrollment System.  Utah Medicaid will alert you when this occurs; you will have time to review your migrated information, to validate that it is correct and make any needed modifications to your information in PRISM.  Providers will receive a letter specifying the updated web address with instructions on how to log in to the updated PRISM Provider Enrollment System to validate and modify information.  eLearning courses will be available to assist with navigating the steps, along with contact information in case you encounter problems during the process.

More details will be communicated in future Medicaid Information Bulletins (MIBs) and on this website.

Core MMIS. The “Core MMIS “component refers to the main functions of the current MMIS system such as Medicaid Manage Care (MMCS), member eligibility, claims adjudication, and claims payment.  All of these pieces of the system will be replaced in early 2022.  Much more detail will be communicated as the date approaches.

Fraud and Abuse System (Audit Studio) and Member Portal.  Audit Studio is the piece of PRISM that will apply new patterns for fraud and abuse detection which reduces the frequency of fraud. Audit Studio allows for criteria creation for monitoring, managing results and generating reports.  Member Portal is the piece of PRISM that will include a web portal for Medicaid members to see an overview of their providers, their benefits and claims. This part of PRISM has a late 2022 implementation date.  More details to come.