Oscar Health × Parallel

Ways Oscar Health could use the Decisions API

Health insurer and healthcare technology company serving consumers and partners.

HealthcareSells to consumers500–5,000 employeesRegulatedOnboards third parties

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01choice

Productweekly

Keep Lucie plan listings current by flagging withdrawn plans

Why: Lucie Health Marketplace connects consumers and brokers to individual market plans and supplemental products.¹

Example

Keep Lucie plan listings current by flagging withdrawn plans

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionFor this Lucie plan listing’s state and coverage year, does the insurer’s official marketplace listing show the plan as offered, withdrawn, or unverifiable?

Decision

OfferedRetain the listing
WithdrawnFlag for removal
UnverifiableReview the listing

02choice

Operationsmonthly

Keep the provider directory accurate by flagging outdated addresses

Why: Oscar requires updated provider rosters to maintain accurate information in its online directory.²

Example

Keep the provider directory accurate by flagging outdated addresses

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionDoes this provider’s stored practice address match the current address published by the provider or its health system?

Decision

MatchesRetain the address
DiffersRequest roster correction
UnverifiableContact the practice

03choice

Supportlive

Resolve Care Team grievances faster by confirming practice locations

Why: Oscar’s Care Team helps members find in-network doctors, and members can file grievances about their care.³⁴

Example

Resolve Care Team grievances faster by confirming practice locations

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionFor this provider named in a member’s grievance, does the provider’s public website show the disputed practice location as open, closed, or unclear?

Decision

OpenContact the practice
ClosedFind alternate providers
UnclearInvestigate the location

04score

Saleslive

Focus CHOICE outreach by prioritizing employers exploring individual coverage

Why: CHOICE supports employees with employer-funded coverage, and Oscar directs employers with 50 or more employees to its employer offering.⁵

Example

Focus CHOICE outreach by prioritizing employers exploring individual coverage

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionHow strong is public evidence that this exact employer offers or is actively exploring an individual coverage health reimbursement arrangement, across its website, job postings, and news?

Decision

StrongStart CHOICE outreach
SomeResearch the employer
None foundUse general outreach

05choice

Saleslive

Speed broker appointments by verifying state license status

Why: Brokers request Oscar appointments for each state in which they wish to sell.⁶

Example

Speed broker appointments by verifying state license status

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionWhat is this broker applicant’s health insurance license status in the requested state according to the state regulator?

Decision

ActiveContinue appointment review
InactiveRequest updated licensing
UnverifiableEscalate for review

06yes / no

Operationslive

Prevent directory duplicates by matching incoming provider roster records

Why: Oscar accepts practitioner and facility rosters to maintain its provider directory.²

Example

Prevent directory duplicates by matching incoming provider roster records

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionDo this incoming provider roster record and this existing directory record refer to the same practitioner at the same practice location, based on public provider sources?

Decision

Yes ≥ 90%Link the records
Yes 50–90%Queue for review
Yes < 50%Keep records separate

07choice

Productmonthly

Keep drug search current by flagging authorization requirement changes

Why: Oscar’s drug formulary lists covered medications and indicates when prior authorization is required.⁷

Example

Keep drug search current by flagging authorization requirement changes

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionFor this stored drug variation and plan year, what prior authorization status does the current official Oscar formulary list?

Decision

RequiredShow authorization requirement
Not requiredRemove authorization flag
UnclearReview formulary entry

08yes / no

Productlive

Make Oswell medication answers safer by screening drug safety claims

Why: Oswell provides on-demand support about medications, test results, symptoms, refills, and drug interactions.⁸

Example

Make Oswell medication answers safer by screening drug safety claims

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionIs the drug safety claim in this proposed Oswell response supported by current FDA or manufacturer prescribing information for this exact medication?

Decision

YesPresent the response
NoEscalate for review

09choice

Supportlive

Resolve Patient Access app questions faster by locating privacy policies

Why: Oscar’s Patient Access API lets members share their health plan data with third-party applications.⁹

Example

Resolve Patient Access app questions faster by locating privacy policies

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionFor this third-party app named in a member support request, is its publicly posted privacy policy current and accessible, inaccessible, or not found?

Decision

AccessibleShare policy link
InaccessibleAsk developer for access
Not foundAdvise member to investigate

10choice

Salesquarterly

Focus +Oscar partnerships by detecting prospect ownership changes

Why: +Oscar offers platform and health plan services to partners across individual, Medicare Advantage, and group business lines.¹⁰

Example

Focus +Oscar partnerships by detecting prospect ownership changes

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionWhat is this exact prospective health plan partner’s current business status based on its website, regulatory sources, and recent reporting?

Decision

IndependentContinue partner outreach
AcquiredResearch new ownership
InactiveClose the prospect
UnclearReview public evidence

11choice

Productweekly

Make provider search more current by flagging patient availability

Why: Oscar helps members find mental health providers through its partnership with Optum Health.¹¹

Example

Make provider search more current by flagging patient availability

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionDoes this behavioral health provider publicly report accepting new patients, not accepting them, or is their current status unclear?

Decision

AcceptingShow availability indicator
Not acceptingFlag for directory review
UnclearRequest provider confirmation

12yes / no

Operationsweekly

Reduce prescription pickup friction by flagging closed pharmacies

Why: Virtual Urgent Care members can choose an in-network pharmacy for their prescriptions.¹²

Example

Reduce prescription pickup friction by flagging closed pharmacies

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionIs this exact pharmacy location still operating, according to current public sources?

Decision

Yes ≥ 90%Retain location listing
Yes 50–90%Queue for review
Yes < 50%Flag location listing

13choice

Supportlive

Resolve prescription support requests faster by checking drug shortages

Why: Oscar’s Care Team helps members with prescription questions, and members may request coverage exceptions.¹³¹⁴

Example

Resolve prescription support requests faster by checking drug shortages

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionFor this member’s prescribed drug and manufacturer, do official sources report an active shortage, a resolved shortage, or no shortage listing?

Decision

Active shortageEscalate prescription assistance
Resolved shortageDiscuss refill options
Not listedContinue standard support

14score

Saleslive

Focus broker outreach by prioritizing individual-market agencies

Why: Oscar supports brokers with plan and network information, training, and local Sales Executives.¹⁵

Example

Focus broker outreach by prioritizing individual-market agencies

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionHow strongly does this broker agency’s public website and independent coverage evidence its focus on individual health insurance: strong, moderate, or limited?

Decision

StrongPrioritize sales outreach
ModerateOffer broker resources
LimitedPlace in nurture

15choice

Riskmonthly

Keep provider credentials current by flagging license status changes

Why: Oscar describes credentialing accreditation and the importance of accurate provider data.¹⁶¹⁷

Example

Keep provider credentials current by flagging license status changes

POST https://api.parallel.ai/v1/decisions

Send with your key in the x-api-key header.

QuestionDo official state licensing records show this provider’s license as active, inactive or restricted, or is its status unconfirmed?

Decision

ActiveRetain credential record
Inactive or restrictedEscalate credential review
UnconfirmedRequest primary source verification

Decisions API docs ↗