Low impactAdministrativeClaims & Billing
Oscar Health: Out of Network Providers - Claims Disputes
Effective dateJan 1, 2022
Found onOct 4, 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 provider claims disputes. Providers who disagree with out-of-network payment amounts must submit negotiation requests to the payer, engage in 30 business days of negotiation, and may then pursue federal IDR resolution if unresolved. All correspondence should be directed 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
- REQUIREMENTS: By immediately: Billing and coding staff must establish internal procedures for handling out-of-network claims disputes under NSA guidelines.
- Train billing team to identify claims eligible for NSA protections (emergency services at OON hospitals, OON providers at in-network facilities, OON air ambulance carriers).
- Document the 30 business day negotiation timeline in claim dispute workflows and tracking systems.
- Establish internal email template and submission process for sending negotiation requests to idr@hioscar.com for disputed OON claims.
- Ensure providers understand they must attempt negotiation before pursuing federal IDR.
- Create a tracking log to monitor negotiation deadlines and escalation to IDR when applicable.
If missed: failure to follow NSA procedures may result in loss of dispute resolution rights and inability to collect undisputed amounts from patients.
Related changes
See all Oscar Health changes →OON 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 & 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