MedicaidAdministrativeMedium impact
March 2023 Medicaid Information Bulletin
Utah Medicaid·UT · Geriatrics, General Practice·Government Programs
Effective date
Mar 1, 2023
We identified it
Jun 21, 2026
Summary
Utah Medicaid is implementing PRISM system changes affecting long-term care billing, Leave of Absence (LOA) day limits, and introducing new billing codes and processes. Key changes include new managed care disenrollment processes for nursing facilities, updated LOA day allowances, and requirement to use new Coverage and Reimbursement Lookup Tool.
Action Required
By March 1, 2023: Update billing systems to use occurrence span code 74 for LOA days in skilled nursing facilities (12 days max), ICF/IID facilities (100 days max), and USDC (25 days max). For additional LOA days, use revenue code 0183 and HCPCS code A9270 with prior authorization. Switch to new Coverage and Reimbursement Lookup Tool using Provider Allowable Code (PAC) instead of provider type for all claims after March 13, 2023. Submit nursing facility admission records in PRISM within 90 days of admission for long-term stays over 30 days.