Oscar Insurance Company of Florida Prior Authorization

Oscar Insurance Company of Florida prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Oscar states that in-network providers generally submit prior authorization requests on behalf of patients. In Florida, providers can submit authorizations through Oscar’s Provider Portal, by phone, and via Cohere Health for certain workflows. Oscar also notes delegated utilization review for specific service categories and directs providers to the applicable vendor when a service is delegated.
• Florida-specific delegated utilization review categories apply for some services; providers may be transferred to or instructed to contact the delegated vendor.
• The published turnaround-time page is general and not Florida-specific.
• The Florida supplement is a 2023 document, so operational details may have changed; use current portal/vendor workflows where available.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Oscar Provider Portal

• phone

• Cohere Health portal for Florida

• delegated vendor portals for delegated services

• Submission resource 1

• Submission resource 2

• Submission resource 3

• Submission resource 4

• Submission resource 5

• Submission resource 6

Information commonly required

• specific code or service
• member plan state
• member identification / plan details as reflected in the provider workflow

Turnaround notes and caveats

• Oscar’s published general prior authorization turnaround page states urgent pre-medical services are 24 to 72 hours and standard pre-medical services are 24 hours to 15 calendar days, with some deadlines extendable by Oscar or the member.
• Florida-specific delegated utilization review categories apply for some services; providers may be transferred to or instructed to contact the delegated vendor.
• The published turnaround-time page is general and not Florida-specific.
• The Florida supplement is a 2023 document, so operational details may have changed; use current portal/vendor workflows where available.

Provider resources

• Provider Resources (official)
• Provider Portal overview (official)
• Prior Authorization List (official)
• Prior Authorization Turnaround Times (official)
• Provider Cover Forms (official)
• Florida Provider Manual Supplement (2023) (official)
• Change Healthcare Outage Provider Resource Center (official)

Sources