Oscar Health Provider Enrollment & Credentialing

Oscar Health is a technology-driven health insurance company that has built its business on ACA Marketplace individual and small group plans. Oscar is known for its member-facing app, concierge care team model, and emphasis on care navigation and preventive care. Since its founding in 2012, Oscar has expanded to over 20 states and serves hundreds of thousands of members through individual and small business plans.

Oscar's approach to provider relations is somewhat different from legacy payers. The company emphasizes its digital-first model and provides providers with a streamlined portal for claims submission, eligibility verification, and prior authorization. Oscar also tends to be more accessible for provider relations inquiries than some of the larger national carriers.

Oscar's network is focused on Marketplace and small group plans — it does not operate Medicare Advantage or Medicaid plans in most markets. For practices with a significant individually-insured patient population or small business employees, Oscar enrollment can be valuable, particularly in markets where Oscar has invested in building a competitive Marketplace presence.

Oscar was one of the first health insurers to eliminate referral requirements for specialist visits, which is worth communicating to patients — Oscar members can see in-network specialists without a referral in most cases. This can be a differentiator for specialist practices considering Oscar enrollment.