Starting May 1, 2023, DHHS will begin issuing a new Medicaid card to replace the old Utah Department of Health (UDOH) card for newly enrolled Medicaid members. Each new Medicaid member will get their own card. Existing members will continue to use their old UDOH Medicaid card. Please accept both DHHS and UDOH Medicaid cards. Learn more in the New Medicaid Card FAQ for Providers.
PRISM Project Go-Live
Background
In April 2023, Utah Medicaid replaced 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. After a soft go-live in January 2023, PRISM is now fully operational with the following components:
- Managed Care Processes
- Prior Authorization
- Member Eligibility
- Claims Adjudication
- Claims Payments
- Member Web Portal
- Audit Studio (Fraud and Abuse System)
Claims Submission
With the new PRISM system, paper claims are no longer accepted. Any paper claims that are received will be securely destroyed and no longer returned to providers or their vendors.
There may be a learning curve to submitting claims for payment. To help provider offices with these changes, virtual calls have been scheduled so that providers can efficiently ask questions and get answers. Get the Provider Billing and Claims Q&A schedule.
Retro-Enrollment for Billing and ORP Provider Types
Utah Medicaid is granting a temporary extension for providers requesting retro-enrollment. The extension will be allowed from April 3 to October 5, 2023, but is contingent upon the provider meeting all credentialing and licensing requirements for the requested retro effective date. If the provider is not licensed or credentialed for the period requested, they will be given the start date of their license. For more information on this topic, please see the following document: Retro-Enrollment for Billing and ORP Provider Types.
Medicaid Ordering and Referring Provider Update
Under the 21st Century Cures Act, State Medicaid Agencies must require all Ordering, Referring, and Prescribing (ORP) providers to enroll with the state Medicaid agency as a Medicaid provider. In addition, certain Medicaid providers, such as Home Health, DME and others, are required to include an ordering/referring provider on their claim to Medicaid. If the ORP is not included and/or is not enrolled with Medicaid, states are required to deny the billing provider’s claim. For more information please see “Medicaid Ordering and Referring Provider Updates”.
PRISM Provider Type, Specialty, and Subspecialty Profile Updates
To become a billing, rendering, referring, or ordering provider for Medicaid, it's crucial to identify your provider type, specialty, and subspecialty. Medicaid's PRISM system requires this information to process and pay claims accurately.
For more information on this and on how to update or submit your provider type, specialty, and subspecialty known to PRISM, please see the PRISM Provider Type, Specialty, and Subspecialty Updates form linked below.
Provider Trainings
To help providers with the system changes, new eLearning courses are available.
Since PRISM launched,Medicaid customer service and provider enrollment staff have noticed a pattern of commonly asked questions received through the Medicaid Hotline. These frequently asked questions will be addressed in upcoming webinars. Get the PRISM Frequently Asked Questions Webinar schedule.
Helpful Resources
Detailed information about PRISM functionality , including claims submissions, can be found in the following materials:
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:
- March 2023 section 23-09 pages 1-6
- January 2023 section 23-01 pages 1-6
- December 2022 section 22-105 pages 1-10
- July 2022 section 22-53 page 2, section 22-54 page 4, section 22-58 page 6
- April 2022 section 22-32 page 6
- January 2022 section 22-02 page 2
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: