Utah has recently completed a groundbreaking initiative to modernize its Medicaid system. The state’s vision was to create a streamlined, efficient system that improved care delivery and health outcomes while optimizing administrative processes. Utah faced numerous challenges that are common across Medicaid programs, including outdated legacy systems, complex regulations, and the need for real-time data analytics to support decision-making. In June 2020, Utah Medicaid went live with its first updated release, the provider enrollment and management module. Then, in April 2023, Utah Medicaid went live with its last release which fully implemented a new system called Provider Reimbursement Information System for Medicaid (PRISM). Utah Medicaid now annually processes approximately six million provider claims plus managed care encounters, paying approximately $5 billion to more than 65,000 active Medicaid providers and managed care organizations.
For a downloadable view of Utah’s Medicaid Modernization Journey Case Study, click the button below.