All PlansAdministrativeMedium impact
OON Providers and Claims Disputes
Oscar Health·Claims & Billing
Effective date
Jan 1, 2022
We identified it
May 16, 2026
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.
Action Required
By immediate implementation: Billing team must establish internal protocol for tracking and managing OON claims disputes under NSA. (1) Create process to identify NSA-covered OON claims (emergency services at OON hospitals, OON providers at in-network facilities, OON air ambulance). (2) Document all disputes with payment amounts and establish 30-business-day negotiation tracking system. (3) After 30-day negotiation period, if unresolved, prepare and submit IDR requests to idr@hioscar.com per federal CMS guidelines. (4) Train billing staff on NSA scope and negotiation requirements. (5) Maintain records of all negotiation correspondence. Failure to follow this process may result in lost opportunity to recover underpayments through IDR and potential revenue impact.