Across the country, Medicaid programs face growing demands for greater agility, stronger compliance, and better overall experience for the people they serve. In this environment, the state of Utah has emerged as a blueprint for what is possible when vision, technology, and strategic partnership align.
Utah’s recent Centers for Medicare & Medicaid Services (CMS) certification of its modernized Provider Reimbursement Information System for Medicaid (PRISM) represents more than a technology achievement. It signals that the future of Medicaid systems is modular, data-driven, and built on thoughtful collaboration. Achieving CMS certification is a rigorous process that signifies the gold standard for clinical and operational excellence. Certification is not simply a milestone to reach. CMS certification is a federal vote of confidence that a state’s Medicaid Enterprise System meets the highest performance, security, and compliance standards. Earning that trust through transparency and integrity is critical in today's environment.
PRISM was developed through close collaboration between Utah's Department of Health and Human Services (DHHS) and the Acentra Health team, with Acentra Health’s evoBrixSM platform to support key Medicaid functions such as provider management, claims processing, member eligibility, and financial reporting. The final CMS certification validates the last major release, which included claims and related modules, and completes a multi-phase rollout.
And the results speak for themselves. Since August 2024, the system has maintained 99.5% production uptime and achieved a perfect record of error-free federal data submissions. These outcomes are critical benchmarks that protect data integrity and help avoid the compliance risks that can arise from reporting gaps.
The larger story is about the intentional design choices and commitment to stewardship that made these results possible. From the beginning, Utah and Acentra Health worked together to meet certification requirements while future-proofing the system against vulnerabilities that often lead to fraud, waste, and abuse.
Utah’s success demonstrates the value of selecting the right technology partner to help maximize resources and safeguard taxpayer dollars. Acentra Health’s broader ecosystem of integrity-focused solutions, including fraud detection tools like ClaimsSure® and audit optimization platforms like Audit Studio®, have been successfully deployed across other states. These solutions help states move from reactive investigations to proactive monitoring, identifying patterns, flagging anomalies, and preventing improper payments before they occur.
Throughout Utah’s Medicaid modernization journey, Acentra Health provided critical support across system architecture, module implementation, federal compliance, testing, and post-launch operations. Utah joins 46 other states that have selected Acentra Health as their partner in mission-critical solutions to support Medicaid programs. This includes Wyoming, which achieved the fastest Medicaid benefit system implementation on record after Acentra Health was selected to replace and modernize a legacy Conduent system that had been in operation since 1993.
Across the country, other Acentra Health client achievements include implementing and certifying a Provider Management Services Module system in Illinois and a shared system for Arizona and Hawaii, as well as developing the first cloud-based Medicaid Enterprise System with Washington’s ProviderOne platform. Acentra Health is also recognized for CMMI Level 3 maturity in state and federal program development; holds URAC accreditation in case management, disease management, health utilization management, and independent review; and is certified in ISO 9001 for quality management.
Utah’s achievement reflects the true power of public-private partnerships in delivering vital healthcare solutions that serve some of the country’s most vulnerable populations. With PRISM fully certified, Utah is now positioned to serve providers and members with greater efficiency, reliability, and responsiveness. Together, Utah and Acentra Health have shown what is possible when modernization efforts are rooted in vision, innovation, excellence, project resilience, and trust.
