PRISM Project Update - Implementation Date Change

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.

Recent user acceptance testing and parallel testing have revealed gaps and defects that the Department of Health and Human Services (DHHS), Division of Integrated Healthcare is working closely with the project vendor (CNSI) to address and resolve. Based on testing results over recent months, we estimate that PRISM project testing and defect corrections will be complete in December 2022.

Assessment

Although DHHS had targeted January 3, 2023 for the PRISM go live date, the completion of system testing and defect corrections in December does not leave adequate time to appropriately train staff or Medicaid providers on the final system before January. Without sufficient training, providers might not submit claims correctly and therefore would not be paid. In addition, some providers may not be able to get the necessary prior authorizations to provide certain services to Medicaid members. Also, the federal public health emergency (PHE) may end in January, causing significant changes to Medicaid enrollment during the same time period which would put more pressure on operations and systems.

Update

In order to provide sufficient time for training and reduce the possibilities of disruptions to services for Medicaid members, DHHS, the Department of Technology Services (DTS), and CNSI are changing the PRISM go live schedule. CNSI and DHHS will complete testing and defect corrections by January 3, 2023 (soft go live) but processing of provider claims and prior authorizations will not begin until April 2023. The new provider go live is scheduled for April 2023. This will give Medicaid staff more time to train and become familiar with the system, and in turn they will be more prepared to support providers using the new system.  DHHS and CNSI will continue to utilize all available resources to meet these deadlines.

With this change, DHHS anticipates that external provider training will occur in February and March 2023. In addition, a system freeze will occur in March 2023 as DHHS transfers data and processes from its current system to PRISM.

DHHS leadership has weighed the costs and risks associated with a three month project delay.  It has been determined that priority needs to be given to providers receiving payments and authorizations for services and individuals receiving medical treatment.  DHHS wants to minimize the disruption from the system migration as much as possible, for all parties involved.

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

You can use this page to stay up to date on important PRISM information, including:

  • Dates and timeline for the PRISM rollout
  • Updates on system features and components
  • Links to available trainings and resources
  • Links to PRISM related MIBs and FAQs

Updates on System Features and Components

The remaining components of PRISM are scheduled to be implemented on April 3, 2023. They include:

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

PRISM Training and Resources

  • eLearnings on PRISM functions

eLearnings are currently available

  • Additional Training

Starting  February 2023, provider specific training will also be available.  Providers may be contacted by Medicaid staff regarding training specific to their area of service.

Medicaid Information Bulletin

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

Multi-Factor Authentication

Starting April 1, 2021, providers will need to go through a multi-factor authentication process to access the PRISM application. Please visit the links below for additional information: