CommercialAdministrativeMedium impact
Credentialing 1 Pager 2
Oscar Health·Network
We identified it
May 9, 2026
Summary
This is an informational credentialing guide for Oscar Health network providers. It outlines the requirements and process for credentialing individual providers and facilities, including required documentation, timelines (up to 45 days), and claim denial consequences for non-credentialed providers. The policy clarifies that providers must be individually credentialed before appearing in the Oscar Provider Directory and that claims will be denied for services rendered by uncredentialed providers.
Action Required
Providers and facilities must ensure all credentialing requirements are met to avoid claim denials: (1) Physicians - Submit roster with First Name, Last Name, Degree, NPI, TIN, Specialty, CAQH ID, and Service Locations; (2) Facilities - Submit facility roster, Oscar Facility Credentialing Application, operating license, Certificate of General and Professional Liability Insurance ($1M per occurrence, $3M aggregate), and accreditation or state/federal site survey (not older than 3 years); (3) For new providers/facilities joining existing groups, email rosters@hioscar.com with required credentialing information; (4) Monitor credentialing status at provider.hioscar.com/provider-credentialing-status and respond promptly to CredSimple requests for missing information; (5) Allow up to 45 days for credentialing processing plus up to 2 weeks for directory appearance. Billing teams should implement workflow to verify provider credentialing status before processing claims, as Oscar will deny claims for non-credentialed providers. Contact credentialing@hioscar.com with questions.