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 updates were made June 29, 2020. The other two components are Core MMIS and Fraud and Abuse.
Components of PRISM
Provider Enrollment. The Provider Enrollment component of PRISM was initially implemented in 2016. Changes and updates to this component were implemented on June 29, 2020 and Medicaid’s provider enrollment records were migrated to the updated system. Providers were sent a letter with log in instructions and information on validating their enrollment information and making any needed modifications.
- If you have NOT validated your information prior to June 29, 2020, your letter will have the application ID (this ID number appears next to your provider name in the greeting line) that you will need to access your account in PRISM.
- If you have validated your information prior to June 29, 2020, your letter will NOT have an application ID. You will not need this ID to enter PRISM.
- Once you are logged in, enter the business process wizard steps that are marked incomplete, make any additional modifications needed, and submit it to the Provider Enrollment team for approval.
eLearning courses are 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.