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In accordance with CMS Final Rule transparency guidelines, Oscar publishes comprehensive prior authorization and appeal statistics for our Individual and Family ACA plans on the Federal Marketplace Exchange, making this data available in a readily accessible format.
In accordance with state laws requiring posting of utilization review statistics for transparency and disclosure purposes, Oscar publishes annual utilization review statistics and makes these reports available in a readily accessible format. Note: State Level Prior Auth Stats are directed by state specific regulations which may differ from other required data disclosures.
Generally, in-network Health Care Providers submit prior authorization requests on behalf of their patients, although Oscar members may contact their Concierge team at (855) 672-2755 to initiate authorization requests and can check authorization status. In-network Health Care Providers can use Oscar’s Provider Portal at provider.hioscar.com or call (855) 672-2755 to confirm authorization requirements for a specific code or service, or to submit an authorization request. For services where Oscar delegates utilization review, you will be transferred to or instructed to contact the appropriate vendor.