Provider Rosters
- TIN and NPI
- PCP status
- Accepting new patients status
- Practice location addresses
- Office phone numbers and emails
- Group and facility affiliations
- Specialties, licenses
- Languages spoken, ages served
- Office hours, ADA accessibility
- Telehealth services
Oscar’s Provider Data Accuracy Initiatives
PCP Panel Status Outreach
In an ongoing effort to leverage the most accurate provider data, Oscar would like to support our provider partners in supplying all necessary data to help us identify your practitioners as Primary Care Providers (PCPs).
Validating this information ensures that our team has access to the most current data for your provider office to support appointment scheduling, claim processing, HMO PCP assignment, and other aspects of patient care.
Office staff languages
NCQA implemented new Health Equity and provider directory requirements which require health plans to collect and display the languages spoken by non-clinical office staff for contracted providers.
The requirement focuses on office staff who speak and interact with members in a language other than English.
FAQs
- Am I required to use Oscar’s new Standard Roster Template?
- We strongly encourage providers to use Oscar’s new Standard Roster Template; however, you may use alternative formats as long as they are aligned with the expectations, delineated below.
- How should I fill out the PCP Indicator column and the Accepting New Patients column?
You may enter the letters “Y”/ “N”, or the full words “Yes/ “No”.
- Am I able to include the specialty name/word instead of the NUCC code?
- We strongly encourage providers to adhere to the industry standard NUCC codes but we will accept specialty names if necessary.
- Do I need to have exactly 5 language columns?
No, you do not. You can have less than five languages, but should not have more than five. If you need to list more than 5 languages, then your provider should be duplicated onto a new row where you may list an additional 5 languages. You may continue this process until you have all necessary languages documented.
- Does English need to be listed in a language column?
No, English does not need to be listed in a language column.
- If I am using Oscar's new Standard Roster Template and the provider only speaks English and Spanish, then can I put Spanish in Column “O” without adding any additional columns?
Yes, English is a default language for all contracted providers.
- Can I still be considered a PCP if I am not accepting new patients?
Yes, our provider directory will still recognize you as a PCP but you will not be eligible for automatic assignment of members.
- What NUCC taxonomies are considered PCP?
- NUCC codes corresponding to the following specialties are considered PCP. Additional NUCC codes may be accepted based on state-specific PCP definitions:Adolescent MedicineFamily Medicine SCPGeneral Pediatric Internal MedicineGeneral Practice MedicineGeriatricianInternal Medicine SCPPrimary Care Nurse PractitionerVirtual Primary CareAdolescent Medicine Nurse PractitionerAdult Health Nurse PractitionerCommunity Health Nurse PractitionerFamily Nurse PractitionerGerontology Nurse PractitionerGynecologyInternal Medicine Nurse PractitionerMedical Physician AssistantNurse PractitionerOBGYN GroupOBGYN Physician AssistantObstetricsObstetrics & Gynecology Nurse PractitionerObstetrics and GynecologyPediatrics Nurse PractitionerPhysician AssistantWomen's Health Nurse Practitioner
Roster Submission Expectations
Required:- Only one file should be sent with all of the requested updates and data elements reflected on it
- The singular file sent must either be a full file or delta file; not both
- All roster updates must be sent in the singular file
- Format of regular update files, sent on either a weekly or monthly basis, should be consistent. Any changes to the format, such as the addition, removal, or reordering of a column, should be communicated beforehand
- File submission in CSV format
- If only sending additions, terminations, and/or changes, these should all be in separate tabs
- One roster per email. If multiple rosters need to be sent, please send them in individual emails
- One roster per State. If multiple States are being sent, please submit them via their own roster
- Sending multiple files with data elements on different files and/or in different formats
- Sending a Word document, PDF, or screenshots
- Using multiple delimiters in the file
- Sending regular updates in a inconsistent formats
- Merged header cells in the file
- Sending updates solely in the body of the email