Oscar Health Maintenance Organization of Florida, Prior Authorization

Oscar Health Maintenance Organization of Florida, publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

At a glance

• Oscar states that in-network providers generally submit prior authorization requests on behalf of members. Providers can confirm requirements, submit requests, and check status via the Provider Portal or by phone; for some delegated services Oscar redirects providers to the appropriate vendor. Oscar also publishes plan-state-specific prior authorization lists, including Florida materials, and turnaround times vary by urgency and service type.
• Oscar’s prior authorization list is plan-state-specific and should be checked against the member’s Florida Evidence of Coverage.
• For services where Oscar delegates utilization review, Oscar instructs providers to contact the delegated vendor.
• No Florida-specific authorization exceptions were located in the sourced materials.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Provider Portal

• phone

• member-initiated via Concierge team

• vendor-directed submission for delegated utilization review

• Submission resource 1

• Submission resource 2

Information commonly required

• specific code or service
• member’s plan state from the Evidence of Coverage
• patient/member plan details

Turnaround notes and caveats

• Urgent pre-medical services: 24 to 72 hours.
• Standard pre-medical services: 24 hours to 15 calendar days.
• Oscar notes these deadlines can sometimes be extended by Oscar or the member.
• Oscar’s prior authorization list is plan-state-specific and should be checked against the member’s Florida Evidence of Coverage.
• For services where Oscar delegates utilization review, Oscar instructs providers to contact the delegated vendor.
• No Florida-specific authorization exceptions were located in the sourced materials.

Provider resources

• Providers landing page (official)
• Provider Resources (official)
• Provider Portal login (official)
• Prior Authorization List (official)
• Prior Authorization Turnaround Times (official)
• Provider rosters (official)
• Provider Cover Forms (official)
• Change Healthcare Outage: Provider Resource Center (official)
• Welcome Packets (official)

Sources