New Jersey IFP Provider Welcome Packet 2021

Welcome to our New Jersey 2021 Network.

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Welcome to our NewJersey 2021 Network.

We?re excit ed t o have you in our New Jersey net work for 2021.
For more informat ion on working wit h Oscar please go t o hioscar.com/ providers or call us at 855- 672- 2755 wit h any quest ions. We look forward t o working wit h you again.
Fr om , The Oscar Provider Team

In your packet :
1. At - a- glance cheat sheet Full of helpful fact s and FAQs, so keep it somewhere handy!
2.2021Provider Fine Print An in- dept h explanat ion of our net work, aut horizat ions, claims and more.
3.St icker Put t his up in your off ice so Oscar members know you?re in- net work!
4.Net work overview For your market wit h key part ners for each of our plans.

Visit hioscar.com/ providers or call 855- 672- 2755 | 1

2021 Provider Fine Print
Visit hioscar.com/ providers or call 855- 672- 2755 | 2

Our plan
We ar e an EPO (Exclu sive Pr ovider Or gan izat ion ) plan w h ich m ean s: - No referrals required - No naming of a PCP required
We of f er t he f ollow ing product s in your m ar ket : - Individual and Family Plans (purchased on or off t he Market place Exchange) - Small Group Plans

New Jersey providers may also be in- net work for our New York Small Group members wit h Circle and Circle Plus plans.
Our net work
Oscar part ners wit h Qualcare in New Jersey. Our net work is available t o all Oscar plans in t he following count ies:

Bergen M i d d l esex Essex Hudson Monmout h Ocean Passaic

Union Morris Som er set Mercer Sussex Hunt erdon War r en

NY/ NJ Access Breakdown

Plan / Member Type New Jersey Net work

NJ IVL

INN

Dent al

INN

New York Circle Net work New York Circle Plus Net work

OON

OON

INN

OON

NY IVL

OON

INN

NY Small Group Circle

INN

INN

NY Small Group Circle Plus

INN

INN

Search for in- net work providers, labs, pharmacies, and hospit als* on hioscar.com/ search.

* See Hospit al and large physician group list s at t he end of t his packet for more det ails

OON OON INN

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Connect wit h us by phone
Call 855- 672- 2755, Mon- Fri: 8am- 6pm EST.
Connect wit h us elect ronically
You can use Oscar?s Provider Resources sit e and Provider Port al t o f ind everyt hing you need t o work wit h Oscar. We built t hese sit es t o simplify your t eam?s workflows so t hat you can focus on delivering great care t o members.
Go t o hioscar.com/ providers t o: - Request t o join t he net work. - Review t he provider manual for reimbursement policies,member right s and responsibilit ies, and more. - Browse resources such as: - Provider Manuals for all market s. - Policies (Clinical Guidelines, Reimbursement Policies, et c.) and forms. - Tut orials and How-To- Guides on using t he provider port al. - Search our provider direct ory for in- net work specialist s, lab facilit ies and more. - Search our drug formulary t o f ind out what medicat ions Oscar covers. - Learn about Oscar's most up- t o- dat e policies regarding COVID- 19.
Creat e a Provider Port al account t o complet e t he f ollowing t asks online: - Check member eligibilit y. - Check st at us of claims. - Submit prior Aut horizat ions elect ronically. - Sign up for elect ronic payment s. - Review members?clinical informat ion. - Connect your st aff t o your organizat ion (pract ice) account and grant permission t o complet e t asks in t he Port al.
Not e: If your off ice is unable t o access t he online resources and you would like a print ed copy of any of t he mat erials (provider manual, et c) faxed t o you, please cont act t he Oscar Provider Team.855- 672- 2755.
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Navigat e our Members?ID Cards
Here?s a sample of our 2021member ID cards: Individual
Small Group
Visit hioscar.com/ providers or call 855- 672- 2755 | 5

Our part ners
Our net work of medical providers is available t hrough our hospit al syst em and provider group part nerships. Our vendors for Behavioral Healt h and Subst ance Abuse, Pediat ric Dent al, Pediat ric Vision, Pharmacy and Laborat ory services are list ed below. Providers must be in- net work wit h t hese vendors for Oscar t o cover t hese services.

Ser vi c e Behavioral Healt h Pediat ric Dent al Pediat ric Vision Laborat ory*

Vendor
Opt um
LIBERTY Dent al
Avesis Vision Quest Diagnost ics (exclusive lab services part ner)

Phone # 877- 614- 0484 888-703- 6999 855- 214- 6777 866- 697- 8378

* Laborat ory:Providers must send lab work t o an in- net work lab facilit y. Search our online direct ory for in- net work labs and conf irm member lab benef it s at hioscar.com/ providers/ resources. Quest Diagnost ics is our exclusive in- net work laborat ory part ner.
In 2021, Oscar?s primary ret ail pharmacy locat ions will be CVS, Target , and Walmart .
Oscar has part nered wit h Capsule, a digit al pharmacy t hat offers free, same- day prescript ion delivery for our members. If you?re int erest ed in part nering wit h Capsule for all your pharmacy needs, visit www.capsule.com/ doct ors. Capsule is only available in Hoboken and Jersey Cit y.
For a complet e list of in- net work ret ail pharmacies, please visit hioscar.com/ search.

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Claims Submission
Our clearing house opt ions are: Availit y, Change Healt hcare, and Eligible.

Ser vi c e

Net work Part ner

Elect ronic Payer ID

Address

Medical Services

Oscar

Behavioral Healt h and Subst ance Abuse Ser vi c es

Opt um

Pediat ric Dent al Ser vi c es
Not e: Oscar does not offer rout ine dent al coverage for adult s

LIBERTY Dent al

Ph ar m ac y

CVS / Caremark

Transplant Relat ed Claim s

Cigna/ LifeSOURCE Opt um

Pediat ric Vision Ser vi c es
Not e: Oscar does not offer rout ine vision coverage for adult s

Avesis Vision

Oscar 87726
CX083
Please reference t he Member ID card for pharmacy claim informat ion
41194
87098

P.O. Box 52146 Phoenix, AZ 85072- 2146
Opt um P.O. Box 30757 Salt Lake Cit y, UT 84130- 0757
LIBERTY Dent al Plan P.O. Box 26110 Sant a Ana, CA 92799
PO Box 3539 Scrant on, PA 18505
Opt umHealt h Care Solut ions PO Box 30758 Salt Lake Cit y, UT 84130
Avesis Claims Depart ment P.O. Box 38300 Phoenix, AZ 85069- 8300

Visit hioscar.com/ providers or call 855- 672- 2755 | 7

Case Management
For comprehensive case management , including complex case management , refer pat ient s t o call 855- 672- 2755. Oscar?s case managers provide dedicat ed support t o our members who request or need ext ra assist ance. This includes assist ance wit h discharge planning, DME, medicat ion adherence, disease specif ic educat ion, and any ot her case management concerns your pat ient has.
For Behavioral Healt h Case Management , refer pat ient s t o Opt um.
Prior aut horizat ion at a glance
Cert ain services at Oscar require prior aut horizat ion. It is import ant t o submit any elect ive or pre- service request s in advance t o ensure everyt hing is in place for your pat ient s t o get t he right care. To conf irm requirement s for a specif ic code or service, request aut horizat ion, or check t he st at us of an exist ing aut horizat ion, reference t he Aut horizat ion Procedure Lookup t ool wit hin Oscar?s Provider Port al. To access or sign up for t he provider port al, visit provider.hioscar.com or call 855- 672- 2755. Aut horizat ion request s may also be submit t ed by faxing t he aut horizat ion request form found in t he Provider Manual t o 844- 965- 9053. Please not e t hat aut horizat ion requirement s may be updat ed t hroughout t he year. To access Oscar?s Provider Manual for your st at e please visit : hioscar.com/ providers/ resources.
Some drugs may require Prior Aut horizat ion before being covered by Oscar. Drug Prior Aut horizat ions may be submit t ed t o Oscar elect ronically t hrough t he EMR/ ePrescribing syst em; online, t hrough www.covermymeds.com/ epa/ caremark; via fax, 844- 814- 2259 (Specialt y drugs) or 844- 814- 2258 (Non- Specialt y drugs); or by calling 855- 672- 2755.
Prior Aut horizat ion review for cert ain services is delegat ed t o eviCore healt hcare. To access eviCore?s clinical crit eria and aut horizat ion request forms, please visit www.evicore.com/ healt hplan/ Oscar. For any ot her services not indicat ed in t hese resources, you can call 855- 672- 2755.
Inclusion of a service in t he Oscar Prior Aut horizat ion List is not a guarant ee of benef it coverage.
Coverage of t hese benef it s may vary by plan, and t he Prior Aut horizat ion list is subject t o change. To verify coverage or prior aut horizat ion requirement s, please call 855- 672- 2755. If prior aut horizat ion is not obt ained for a service t hat requires it , t he service is subject t o post - service (ret rospect ive) review. Some services t hat may be part of an ongoing course of t reat ment may also be subject t o concurrent review. Prior aut horizat ionrequirement s (including concurrent and/ or ret rospect ive review) for Behavioral Healt h and Subst ance Abuse are subject t o t he policies and procedures of Opt um. Please reference t he provider manual for Prior Aut horizat ion requirement s for our vendors.
Visit hioscar.com/ providers or call 855- 672- 2755 | 8

The 2021 Network: New Jersey
Getting care in New Jersey made easy.
We provide high-quality care in New Jersey, with partners like QualCare. Oscar's New Jersey service area includes Bergen, Middlesex, Essex, Hudson, Monmouth, Ocean, Passaic, Union, Morris, Somerset, Mercer, Sussex, Hunterdon, and Warren counties.*
hioscar.com

The 2021 Network: New Jersey

Our 2021 Participating Hospital List

Atlantic
AtlantiCare Regional Medical Center - Mainland Division AtlantiCare Regional Medical Center - City Division Shore Medical Center
Bergen
Bergen New Bridge Medical Center Englewood Hospital and Medical Center Pascack Valley Medical Center Hackensack University Medical Center Holy Name Medical Center The Valley Hospital
Burlington
Deborah Heart and Lung Center Lourdes Medical Center of Burlington Virtua Marlton Hospital Virtua Memorial Hospital
Camden
Cooper University Hospital Jefferson Cherry Hill Hospital Jefferson Stratford Hospital Our Lady of Lourdes Medical Center Virtual Berlin Hospital Virtua Voorhees Hospital

Cape May
Cape Regional Medical Center
Cumberland
Inspira Medical Center Vineland
Essex
Clara Maass Medical Center East Orange General Hospital Mountainside Medical Center Newark Beth Israel Medical Center Saint Barnabas Medical Center Saint Michael's Medical Center University Hospital
Gloucester
Inspira Medical Center Woodbury Jefferson Washington Township Hospital
Hudson
Jersey City Medical Center Palisades Medical Center
Hunterdon
Hunterdon Medical Center

hioscar.com