For most health plans, the clinical evidence exists. The problem is it's buried in unstructured documents, siloed across systems, and never makes it into the risk workflow. OnyxOS connects the full picture — so nothing gets missed.
OnyxOS brings together the full depth of the payer data stack — acquiring clinical and claims data at scale, structuring it into a longitudinal member record, and applying intelligence that continuously surfaces risk opportunities, reconciles diagnoses, and keeps your program audit-ready.
This isn't a point solution bolted onto your existing workflow. It's risk adjustment built into an operating system that already knows your members.
Continuously identifies unrecaptured Hierarchical Condition Categories across your membership — drawing on both clinical and claims signals to surface gaps before the window closes.
Prioritizes members and diagnoses by revenue impact and recapture likelihood, so clinical and coding teams focus where it matters most.
Run suspecting workflows forward and backward — identifying opportunities for the current plan year while reconciling prior-period diagnoses for retrospective accuracy.
Matches clinical evidence from EHR, HIE, and unstructured documents against claims to validate, correct, and complete diagnosis coding at scale.
Maintains a continuously updated audit trail linking every diagnosis to supporting clinical documentation — so when CMS calls, you're ready.
Diagnoses that reflect true member acuity, not just what made it through the claims process.
Risk opportunities surfaced continuously, not at the end of a manual chase cycle.
Clinical document retrieval and review automated at scale, freeing teams for higher-value work.
Complete, traceable documentation ready before the audit begins.
Risk adjustment isn't a standalone problem — it's a data problem. OnyxOS solves it at the foundation, connecting data acquisition, clinical structuring, and intelligence into a single operating system for payer performance.
Explore the OnyxOS platformA regional health plan needed to identify patients matching complex risk criteria across thousands of unstructured clinical documents — PDFs, scanned records, clinical notes. Traditional keyword search broke down against clinical abbreviations and varied provider terminology.
Talk to an Onyx expert about building a risk adjustment workflow that runs on complete clinical intelligence — not incomplete data.
