All PlansAdministrativeMedium impact
NSA info
Oscar Health·Claims & Billing
Effective date
Jan 1, 2022
We identified it
May 9, 2026
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.
Action Required
By 2022-01-01: Billing team must establish procedures for out-of-network claims disputes under NSA. (1) Train billing staff on the 30-business-day negotiation requirement for disputed OON claims. (2) Create internal workflow to track negotiation timelines and escalate unresolved disputes to IDR after 30 business days. (3) Configure billing system or create manual tracking to log all NSA-eligible disputes (emergency services, OON providers at in-network facilities, air ambulance claims). (4) Update provider communication templates to reference idr@hioscar.com as the submission point for federal IDR requests. (5) Ensure all correspondence related to NSA disputes is properly documented and retained. Failure to follow the 30-day negotiation period may result in loss of right to pursue IDR resolution.