Utah Medicaid is in the process of replacing MMIS and MMCS with a new system called PRISM, which will go-live on April 3, 2023. In preparation, the Medicaid systems will “freeze” operations from March 13 through April 2, 2023. The system freeze will impact provider enrollment, claims processing and payments, medical prior authorizations, and pharmacy prior authorizations for pharmacy-related HCPCS codes.
For more information and trainings, please visit medicaid.utah.gov/prism.
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:
- Utah Medicaid PRISM Update (December 2022)
- December 2022 MIB, pages 1-10
- January 2023 MIB
- Utah Medicaid System Freeze FAQ
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:
- January 2022 section 22-02 page 2
- April 2022 section 22-32 page 6
- July 2022 section 22-53 page 2
- July 2022 section 22-54 page 4
- July 2022 section 22-58 page 6
- December 2022 section 22-105 pages 1-10
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: