DHHS updates Medicaid system

Utah’s Department of Health and Human Services (DHHS) has converted and launched its new Medicaid claims payment system, known as the Provider Reimbursement Information System for Medicaid (PRISM), the agency said. 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{mprestriction ids="1,3"} grateful to our state departments, federal partners and providers for making this happen,” said 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 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.

Strohecker said 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 members have spent months providing regular and ongoing training for all users. DHHS staff provided and will continue to provide pre-recorded PRISM trainings, e-learnings, desktop guides, and other resources to providers and the public.{/mprestriction}