Oscar Health billing and credentialing
Billing and credentialing for Oscar Health individual and family (Marketplace) plans.
Working with Oscar Health
Oscar Health mainly offers ACA Marketplace plans in a number of states, with narrow networks in many markets.
Plan types we bill:
- Individual and family Marketplace plans
- Small business plans in some markets
Credentialing and enrollment
Credentialing uses your CAQH ProView profile, so it must be complete, attested within the last 120 days and authorized for the payer before the application is reviewed.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Oscar provides its own provider portal for eligibility, claims and authorizations. Network status matters because many plans are EPOs with limited out-of-network coverage.
Denials we prevent with Oscar Health
- Provider not credentialed or not linked to the group TIN
- Missing prior authorization for services on the payer’s list
- Eligibility or coordination of benefits issues
- Coding edits and bundling under payer policy
- Claims filed after the contract’s filing limit
- Out-of-network services under EPO plans
- Members in the grace period for unpaid premiums
Questions about Oscar Health
Why are Marketplace claims sometimes pended?
Marketplace members with subsidies have a grace period for unpaid premiums, and plans may pend claims during part of it.
Other payers and related services
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Oscar Health claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.