Summary
Oscar Health is consolidating prior authorization workflows by moving authorization submissions from the Oscar Provider Portal to Availity Essentials (effective September 1, 2026 nationally, August 17 in Florida). Additionally, select prior authorization requests currently processed through eviCore (Radiology, Cardiology, Joint Surgery, Spine Surgery, Sleep Management, and Interventional Pain) will transition to Oscar using Milliman Care Guidelines (MCG) starting October 19, 2026. The billing team must establish Availity Essentials access before September 1 and update authorization submission workflows accordingly.
Get alerts when payers change rules like this one
We check Oscar Health and other payers every day and email you when a change matches your specialty and state.
Get Oscar Health alertsPolicy Monitoring is free. No card required.
What to do
Action · 15 steps
01REQUIREMENTS:
1. By August 17, 2026: Billing and administrative staff must confirm active Availity Essentials account access linked to your organization's administrator account.
02If staff lack accounts, request invitations from your organization's Availity administrator immediately.
03Complete this before August 17 launch of new features.
042. By September 1, 2026: Billing team must cease all new authorization request submissions through the Oscar Provider Portal.
05All authorization requests must be submitted exclusively through Availity Essentials to prevent claim delays and denials.
06Update internal workflows and staff training to reflect this change.
073. By September 1, 2026: Billing staff should review and save the "OON Exception" form from Oscar Payer Space in Availity Essentials to use for all out-of-network authorization requests submitted online (no more faxing required).
084. By October 19, 2026: Update authorization submission processes for Radiology and Advanced Imaging requests—these will now be submitted through Availity Essentials and reviewed using MCG guidelines instead of eviCore.
09Review Oscar Medical Guidelines library to understand updated clinical criteria.
105. By December 2026: Update authorization submission workflows for Cardiology, Joint Surgery (MSK), Spine Surgery (MSK), Sleep Management, and Interventional Pain requests—these categories will transition from eviCore to Oscar/Availity Essentials using MCG guidelines.
11Billing staff must familiarize themselves with MCG clinical criteria for these specialties before December transition.
126. Florida-specific: Effective August 17, 2026, all Florida radiology prior authorization requests must be submitted through Availity Essentials instead of eviCore using MCG guidelines.
137. Ongoing: Billing team should access on-demand training videos in Availity Essentials Learning Center (Help & Training | Get Trained) and consult guides in Oscar Payer Space Resources section.
14For support, call Availity Essentials at 1-800-AVAILITY (282-4548), Monday-Friday, 8 a.m. to 8 p.m. EST.
15CONSEQUENCES: Failure to transition to Availity Essentials by September 1 will result in authorization requests being rejected or delayed, causing patient care delays and potential claim denials.
Original notice
Provider Newsletter - August 2026
cdn.sanity.io · Always check the source before changing claims.
Related changes
See all Oscar Health changes →Provider Newsletter - November 2026HighNo effective date · Provider NewsletterProvider Newsletter - October 2026HighEffective Oct 1, 2026 · Provider NewsletterProvider Newsletter - January 2026MediumEffective Jan 1, 2026 · Provider NewsletterProvider Newsletter - February 2026MediumNo effective date · Provider NewsletterBrowse every Oscar Health change in the policy list