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Utah PRISM Project - Release 3 and ICD-10
Nursing Home Association Meeting 4/20/2015
Presented By:Division of Medicaid and Health Financing
• Design, Development, and Implementation – March 2013 to March 2017
– Four Releases• Release 1 (New Medicaid Website and Eligibility Lookup Tool)
– Completed March 30, 2014• Release 2 (HealthBeat)
– Completed August 1, 2014• Release 3 (Provider Portal and Enrollment, eMIPP, Provider Credentialing
Service) – December 2015
• Release 4 (Remaining MMIS) – Summer 2017
PRISM Project Overview
• Release 3 is planned for December 2015• Three Major Components:
1. Provider Enrollment 2. Provider Credentialing Services (which is part of Provider Enrollment)3. eMIPP (Electronic Medicaid Incentive Payment Processing)
• New Medicaid Providers:- Enroll online using PRISM
• Current Medicaid Providers:- Existing enrollment information will be converted to PRISM- Providers will need to validate their enrollment information and make
any needed changes to their information using PRISM• This will occur in the stages prior to Release 4
- Providers will be notified when they need to access PRISM to validate their enrollment information
• Claims will still be paid out of the Legacy MMIS until Release 4 (Summer 2017)
PRISM Release 3 - Overview
The Provider Portal houses data to manage and maintain the status of all providers paid through and/or reporting services rendered to Medicaid members.
Release 3 • Providers enroll online • Automated business processes• Includes automated Provider Credentialing Services • Includes Kofax®, imaging software for managing faxes in
PRISM• Includes Siebel, a customer relationship management (CRM)
system used to capture notes from callers
PRISM Release 3 – Provider Enrollment
Provider Credentialing Services (PCS) provides a real-time one-stop provider credentialing solution for complying with the ACA Provider Enrollment Screening requirement.
• Automatically checks various databases simultaneously to see if the provider has a valid license, and/or any sanctions, criminal charges, etc.
• Available in real-time for the provider enrollment specialist to review and make appropriate decisions
• Provides improved automation and reduced manual intervention
PRISM Release 3 – Provider Credentialing Services
Electronic Medicaid Incentive Payment Processing (eMIPP) supports federal incentive payment programs to encourage providers and hospitals to adopt, implement, or upgrade certified electronic health record technology and use it in a meaningful manner.
• eMIPP will replace the current HIT (Health Information Technology) program
PRISM Release 3 - eMIPP
PRISM Release 3 – Implementation Activities
Provider Outreach• Medicaid Information Bulletin (MIB) article in February
introducing Release 3 functionality, PRISM webpages and [email protected] email
• Attending meetings to solicit providers to participate in system testing (primarily), message input, and material review
• Provider review of training materials: June and July 2015• Provider testing: September 2015• Release 3 messages on the PRISM webpages• Statewide Provider Training: July 28 – October 1• July and October MIB articles
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO).
• DMHF is on target to process claims for the October 1, 2015ICD-10 deadline
• System testing will occur June – September• An ICD-10 article has been included in the April MIB
ICD-10
Provider participation is primarily requested for: • Assistance with System Testing
• ICD-10: June through September 2015• PRISM Release 3: September 2015
Provider participation is also requested for: • Input into Messaging for PRISM, Release 3
• Ideas on how to word messages to providers• Where the messages should be delivered (e.g., MIB article, other
communication tool)• April – November, intermittently with minimal time commitment
• Material Review for PRISM, Release 3• MIB articles, training materials, etc. • April – November, intermittently with minimal time commitment
PRISM Release 3 and ICD-10 Provider Participation
PRISM Release 3 and ICD-10 Implementation Timeline
Implementation Timeline and Summary of Activities
PRISM R3
ICD-10
April May June July August September October November December
R3 UAT Provider Testing:
September
R3 Provider Training:Oct - Nov
R3 Go-Live:
Dec 2015
ICD-10 Provider Testing: June - September
ICD-10 Go-Live: Oct 2015
If interested in participating in system testing for PRISM Release 3, or for questions about PRISM, contact:
Email: [email protected]
If interested in participating in system testing for ICD-10, contact:
Email: [email protected]
Participation will be greatly appreciated & beneficial to the implementation of the new systems.
PRISM Release 3 and ICD-10
