Oscar Health Plan of North Carolina Prior Authorization

Oscar Health Plan of North Carolina 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 whether a specific code/service requires authorization, submit a request, or check status through the Oscar Provider Portal. Members may also initiate authorization requests by contacting Concierge. Some services are delegated to vendors such as eviCore, and PT/OT after 5 visits is delegated to ASH. A North Carolina provider welcome packet also says authorization requests may be submitted by fax using Oscar's authorization request form.
Authorization rules can vary by plan state, line of business, and delegated vendor.
Oscar notes authorization requirements may be updated throughout the year.
The North Carolina welcome packet reviewed is for 2023 and may be outdated for some operational details.

Where to verify prior authorization requirements

How to submit prior authorization requests

Provider Portal
Fax
Phone
Electronic submission through EMR/ePrescribing for pharmacy prior authorization
Delegated vendor workflows when applicable (eviCore, ASH)
Submission resource 1
Submission resource 2
Submission resource 3

Information commonly required

Member-specific plan/state information
Specific code or service being requested
Clinical details supporting medical necessity
For portal/phone eligibility or authorization lookups, provider TIN and NPI
For phone self-service eligibility, three of four member identifiers: Oscar ID, date of birth, last 4 digits of SSN, and/or phone number

Turnaround notes and caveats

Oscar says elective or pre-service requests should be submitted in advance.
No general turnaround time for prior authorization review was located in the official sources reviewed.
Delegated vendor timelines may differ by vendor and service.
Authorization rules can vary by plan state, line of business, and delegated vendor.
Oscar notes authorization requirements may be updated throughout the year.
The North Carolina welcome packet reviewed is for 2023 and may be outdated for some operational details.

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

Fact	Value	Source	Confidence
Prior authorization overview	In-network Health Care Providers can use Oscar’s Provider Portal ... to confirm authorization requirements ... or to submit an authorization request.	Official	high
Member/provider initiation	Generally, in-network Health Care Providers submit prior authorization requests ... members may contact Concierge to initiate authorization requests.	Official	high
Delegation	For services where Oscar delegates utilization review, you will be transferred to or instructed to contact the appropriate vendor.	Official	high
NC packet auth workflow	Authorization requests may also be submitted by faxing the authorization request form located at hioscar.com/forms.	Official	high
Portal self-service	To confirm requirements for a specific code or service, request authorization, or check the status of an existing authorization, reference the Authorization Procedure Lookup tool within Oscar’s Provider Portal.	Official	high

Last reviewed: March 27, 2026

Sources used: 2 official