DHHS successfully launches new Medicaid provider payment system

This project advances operations to better serve Medicaid providers and members

Salt Lake City—Last week, the Department of Health and Human Services (DHHS) successfully converted and launched the new Medicaid claims payment system, known as the Provider Reimbursement Information System for Medicaid (PRISM).  PRISM replaces previous operating systems that served the state for more than 40 years. The new PRISM system is customer-centered and aligns with DHHS’s vision to build a seamless system of services and programs.

“This effort took years of collaboration and we’re very grateful to our state departments, federal partners, and providers for making this happen,” said Utah Gov. Spencer J. Cox. “Streamlining processes like this is a great example of good government and we’re excited about this achievement.”

“This is a gratifying time to be at DHHS, as we complete and implement a system that has been years in the making,” said Jennifer Strohecker, Utah Medicaid director.  “We are grateful for the resources provided to develop and launch this critical system that will better serve the state and its citizens for decades to come.” 

The new system includes essential components such as provider enrollment, claims adjudication and payment, prior authorizations, managed care processes, and a member web portal. This launch impacts healthcare providers across the state that are enrolled with Medicaid, Medicaid managed care plans, and DHHS staff.  Examples of system advancements and efficiencies that reduce administrative burden include:

  • An interface that is user-friendly and more accessible as a web-based system.
  • The ability for providers and their staff to now check the status of a claim online and see the adjudication results, instead of having to call the Medicaid office and rely on staff to look up the information.  
  • The capability for providers to enter their own prior authorization request through direct data entry (DDE) instead of sending it via fax, allowing provider offices to operate more efficiently.  

To help providers prepare for the launch and navigate this new system, DHHS staff have spent months providing regular and ongoing training for all users. DHHS staff provided and will continue to provide pre-recorded PRISM trainings, eLearnings, desktop guides, and other resources to providers and the public, which are all available on the PRISM website. Additionally, to ease the transition, Medicaid customer service hours of operation will be extended from 7 a.m. to 7 p.m. MDT, Monday through Friday, through April 21, 2023.  

The new system was developed by state staff and a contractor, CNSI.  The system has already successfully completed the federal Centers for Medicare and Medicaid Services Operational Readiness Certification Review and is anticipated to complete the remaining certification activities in 2024.

Medicaid is a state and federal program, providing vital healthcare to vulnerable and low-income Utahns of all ages statewide.  Utah Medicaid provides health coverage to 524,000 individuals in the state and has more than 45,000 providers enrolled to deliver these services.