PRISM Project Go-Live

Background

Utah Medicaid is in the process of replacing the Utah Medicaid Management Information System (MMIS) with a new system called Provider Reimbursement Information System for Medicaid (PRISM). The Provider Enrollment component of PRISM was implemented in 2016 and updated in June 2020. The remaining components were previously scheduled to go live on January 3, 2023. After a soft go-live in January, PRISM will be fully operational and go-live on April 3, 2023 with the following components:

  • Managed Care Processes
  • Prior Authorization
  • Member Eligibility
  • Claims Adjudication
  • Claims Payments
  • Member Web Portal
  • Audit Studio (Fraud and Abuse System)


System Freeze

To support the conversion of data from the current MMIS and MMCS systems to the PRISM system, a “freeze” of system functions will occur. This is a standard process for system conversions that will impact operations. The Medicaid systems will “freeze” operations from March 13 through April 2, 2023. For more information, please refer to the Utah Medicaid System Freeze FAQ.


Claims Submission

With the new PRISM system, paper claims will no longer be accepted. The last day to submit paper claims will be February 22, 2023. Paper claims received on or after February 23, 2023, will be securely destroyed and no longer returned to providers or their vendors.

Additionally, providers can submit electronic claim inquiries (276/277 and 837) until March 8, 2023 at 5:00 p.m. MST. Any electronic claim inquiries submitted after that date/time will be processed after the freeze period ends.


Helpful Resources

More detailed information about PRISM go-live, system freeze, and claims submissions can be found in the following materials:

Important Dates and Timeline

Date

What’s Coming?

August 16, 2022

Statewide Provider Training for PRISM Overview

January 2023 to March 2023

Provider testing for some providers

February 2023 to March 2023

Medicaid system provider trainings will be available

March 13, 2023 to April 3, 2023

Medicaid System Freeze. Providers will not have access to the Medicaid systems during this time period. (Additional information on the freeze will be coming)

April 3, 2023

Go-live for the new PRISM components

Provider Trainings

  • eLearnings on PRISM functions are currently available.
  • Live and recorded trainings are scheduled for February and March.  Some providers may be contacted by Medicaid staff regarding training specific to their area of service.

Medicaid Information Bulletin

Medicaid Information Bulletin (MIB) articles are published throughout the year with information on how PRISM will impact providers. View the PRISM related MIB articles below:

Multi-Factor Authentication

Providers will need to go through a multi-factor authentication process to access the PRISM application. Please visit the links below for additional information: