Oscar Ins Co of Texas Prior Authorization

Oscar Ins Co of Texas 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 health care providers generally submit prior authorization requests on behalf of patients. Providers can use the Oscar Provider Portal or call provider services to confirm whether a code/service needs authorization and to submit the request. For services where Oscar delegates utilization review, Oscar directs providers to the appropriate vendor. Texas-specific public pages indicate that specialist referrals are required for TX Guided Care HMO plans, but that is a referral rule rather than a general prior-authorization rule.
• Public pages do not expose a Texas-only prior authorization manual in the sources reviewed.
• Authorization handling may vary for delegated services and by plan type.
• Members may initiate authorization requests, but Oscar says in-network providers generally submit them.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Provider Portal

• Phone

• Member concierge / care team initiation for members

• Fax or delegated vendor when applicable

• Submission resource 1

• Submission resource 2

Information commonly required

• Specific code or service to check authorization requirements
• Member plan/state context
• Request details submitted via portal or by phone
• Any delegated utilization review vendor information if Oscar routes the request externally

Turnaround notes and caveats

• No general prior-authorization turnaround-time standard was found in the public provider pages reviewed.
• Oscar publishes prior authorization statistics, but no provider-facing turnaround SLA was located in the sources reviewed.
• Public pages do not expose a Texas-only prior authorization manual in the sources reviewed.
• Authorization handling may vary for delegated services and by plan type.
• Members may initiate authorization requests, but Oscar says in-network providers generally submit them.

Provider resources

• Oscar Providers landing page (official)
• Oscar Provider Portal overview (official)
• Prior Authorization List (official)
• Provider Cover Forms (official)
• Change Healthcare outage provider resource center (official)
• Texas Welcome Packets (official)
• Texas Forms (official)

Sources