Utah Medicaid requires that providers enter enrollment information into the PRISM portal before they can send or receive EDI transactions with Medicaid.
If a claim is sent before this step has been completed, the claim will error out during transmission to Medicaid without generating an error report. Or, the claim will reject on the 277CA with a reason indicating a problem with the NPI plus "claim/encounter not found."
If you are experiencing either issue, we recommend that providers check their PRISM settings by following these steps:
- Log into the PRISM portal. You can find it by going to https://medicaid.utah.gov/accessing-prism/ and clicking on Provider Portal.
- You will need to log in with your PRISM credentials.
- The username will not be your email address; it is usually based on the organization name.
- If you don't know your credentials or have trouble logging in, please contact Medicaid for assistance at 800-662-9651 opt 3, opt 4.
- Once you have entered your username and password, you will be prompted to enter a domain. This is provided by Medicaid and typically looks like your username followed by your Medicaid contract number or contract date.
- On the PRISM landing page, look on the right side and select Manage Provider Information. You will get to a screen with numbered steps.
- Click on the step named EDI Submission Methods (usually step 8). If nothing has been added to this section, please click the Add button on the upper left to add transactions here.
- Find the section for EDI Submission Details - UHIN, and check the box next to Mode of Submission: UHIN.
- Select your desired EDI transactions on the left and move them to the box on the right. We recommend at minimum selecting the type of claim you will need to submit (professional, institutional, or dental), the 835, and 270/271.
- Once this is complete, save.
- Click on the step named Trading Partner Details (usually step 9). Click the Add button on the upper left to add details. All EDI transactions selected in the previous step will show in the list. Enter your UHIN account number (Trading Partner Number, or HT#) into the blank field next to each transaction type.
- Once the above steps are completed, you may want to check the remaining steps to ensure the contact information and 835 preferences are up to date.
- When done, complete the attestations on the step named Complete Modification Checklist.
- Submit on the step named Submit Modification for Review.