Low impactAdministrativeClaims & Billing
Oscar Health: OON Providers and Claims Disputes
Effective dateJan 1, 2022
Found onMay 16, 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) negotiation and Independent Dispute Resolution (IDR) process for out-of-network claims. Healthcare providers who disagree with OON payment amounts must submit a negotiation request to the payer, engage in 30 business days of negotiation, and may then pursue federal IDR resolution if unresolved. All IDR correspondence must be submitted to idr@hioscar.com.
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
Action · 6 steps
- By immediate implementation: Billing team must establish internal protocol for tracking and managing OON claims disputes under NSA.
- Create process to identify NSA-covered OON claims (emergency services at OON hospitals, OON providers at in-network facilities, OON air ambulance).
- Document all disputes with payment amounts and establish 30-business-day negotiation tracking system.
- After 30-day negotiation period, if unresolved, prepare and submit IDR requests to idr@hioscar.com per federal CMS guidelines.
- Train billing staff on NSA scope and negotiation requirements.
- Maintain records of all negotiation correspondence.
If missed: failure to follow this process may result in lost opportunity to recover underpayments through IDR and potential revenue impact.
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 & BillingLowNSA infoThis 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…Effective Jan 1, 2022 · Claims & BillingLow