How To Submit Claims To Oscar Health Plan of North Carolina

For Oscar Health Plan of North Carolina, the practical claims workflow usually starts with electronic submission guidance and only falls back to paper instructions when the payer documents a mailing address for specific claim types or exceptions. The details below keep the workflow broad instead of reducing it to a single address.

At a glance

• Oscar's official provider materials say the provider portal can be used to view claims, check claim status, and upload forms. The North Carolina provider welcome packet states Oscar uses Change Healthcare as its clearinghouse, gives a 30-day claims processing deadline for the state, and lists the paper claims address for medical services as Oscar, P.O. Box 52146, Phoenix, AZ 85072-2146. The packet also notes claim status can be checked in the provider portal. Oscar's portal resource center also references Availity as a route by which Oscar receives some claims.

Submission channels

• Provider Portal
• Clearinghouse via Change Healthcare
• Paper mail for medical claims
• Electronic submission for pharmacy claims through CVS/Caremark processes
• Electronic remittance/advice via Oscar provider portal

Electronic claims payer IDs

• Oscar (medical network partner payer ID shown in the North Carolina welcome packet is not clearly readable in the extracted text)
• 87726 (Optum behavioral health payer ID in the North Carolina packet)
• 4000000027 (Davis Vision payer ID in the North Carolina packet)

Paper claims addresses

• Oscar, P.O. Box 52146, Phoenix, AZ 85072-2146 (medical services)
• CVS/Caremark, P.O. Box 52136, Phoenix, Arizona 85072-2136 (pharmacy claims)
• PO Box 3539, Scranton, PA 18505 (transplant-related claims)
• OptumHealth Care Solutions, 41194, PO Box 30758, Salt Lake City, UT 84130 (as displayed in the packet for transplant-related claims routing)

Corrected claims and follow-up

• Use the Provider Portal for claims disputes; Oscar states the portal is the best way to send a dispute and track progress.

• Effective October 1, 2025, the Claims Disputes Provider Form is required to process the request.

• If faxing or mailing a dispute, complete the required Claims Disputes form.

• Claims status resource 1

• Claims status resource 2

Caveats

• Claim submission channels vary by claim type (medical, pharmacy, behavioral health, vision, transplant-related).
• The North Carolina provider packet is from 2023 and may not capture all current electronic payer IDs or routing details.
• The extraction quality of the PDF is imperfect, so some payer-ID text was not fully readable.

Provider resources

• Providers landing page (official)
• Provider Portal login (official)
• Provider resources (official)
• Provider manual link from providers page (official)
• Prior Authorization List (official)
• Provider Cover Forms (official)
• North Carolina Provider Welcome Packet (official)

Sources