Claims-only payment validation leaves too much on the table. When clinical data is absent from the review process, overpayments slip through, investigations stall, and leakage compounds. OnyxOS applies unified clinical and claims intelligence across the full payment lifecycle.
OnyxOS connects clinical and claims data into a unified view of every member, provider, and encounter — then applies intelligence across pre-pay validation, post-pay recovery, and ongoing fraud, waste, and abuse detection. Payment decisions are made with full context. Anomalies are scored and surfaced automatically. And policy impacts are visible before they become liabilities.
Validates claims against clinical context before payment — catching errors, unsupported diagnoses, and billing inconsistencies that claims-only edits miss.
Identifies overpayment patterns across historical claims, prioritizes recovery opportunities by value, and surfaces trends that indicate systemic issues.
Detects fraud, waste, and abuse patterns across providers, members, and time periods — using longitudinal clinical and claims signals that point-in-time review misses.
Continuously monitors payments against contracted rates and terms, flagging variances and systematic billing deviations in real time.
Scores individual providers against peer benchmarks and historical patterns to identify outlier billing behavior before it escalates.
— clinical context closes the gaps that claims-only validation leaves open.
— anomalies surfaced and prioritized automatically, so investigative teams focus on confirmed risk rather than chasing signals.
— pre-pay validation that catches errors before they become recoveries.
— visibility into how payment policies translate to financial outcomes, so changes can be evaluated before they're made.
You can't validate what you can't see. OnyxOS builds the longitudinal clinical and claims record that makes complete payment review possible — connecting data sources that have never been in the same workflow before.
Explore the OnyxOS platformTalk to an Onyx expert about building a payment integrity program that runs on the complete picture.
