Low impactAdministrativeClaims & Billing
Oscar Health: NSA info
Effective dateJan 1, 2022
Took effectJan 1, 2022
Found onMay 9, 2026
Oscar Health · The summary is ours. The payer's notice is the final word.View original ↗
Summary
This policy outlines the No Surprises Act (NSA) procedures for handling out-of-network claims disputes. Providers must follow a 30-business-day negotiation process with payers before escalating to federal Independent Dispute Resolution (IDR). Disputes must be submitted to idr@hioscar.com for resolution under CMS guidelines.
PolicyChanges checks Oscar Health and other payers every day and shows what to do before a change takes effect.
See every Oscar Health changeWhat to do
Took effect Jan 1, 2022 · 6 steps
- Billing team must establish procedures for out-of-network claims disputes under NSA.Passed
- Train billing staff on the 30-business-day negotiation requirement for disputed OON claims.Passed
- Create internal workflow to track negotiation timelines and escalate unresolved disputes to IDR after 30 business days.Passed
- Configure billing system or create manual tracking to log all NSA-eligible disputes (emergency services, OON providers at in-network facilities, air ambulance claims).Passed
- Update provider communication templates to reference idr@hioscar.com as the submission point for federal IDR requests.Passed
- Ensure all correspondence related to NSA disputes is properly documented and retained.Passed
If missed: failure to follow the 30-day negotiation period may result in loss of right to pursue IDR resolution.
Related changes
See all Oscar Health changes →Out of Network Providers - Claims DisputesThis policy outlines the No Surprises Act (NSA) negotiation and Independent Dispute Resolution (IDR) process for out-of-network provider claims disputes. Providers who disagree…Effective Jan 1, 2022 · Claims & BillingLowOON Providers and Claims DisputesThis policy outlines the No Surprises Act (NSA) negotiation and Independent Dispute Resolution (IDR) process for out-of-network claims. Healthcare providers who disagree with OON…Effective Jan 1, 2022 · Claims & BillingLow