A fully engineered, deployment-ready 10-project operational transformation program. Every project pre-scoped, pre-built, and financially validated. Deploy from Day 1. No consulting required. No design work needed. Authorize and execute.
The Claims Edit Prevention & Revenue Integrity HOIP is not a framework, a template library, or a consulting recommendation. It is a deployment-ready operational transformation program — 10 DMAIC projects, fully scoped, financially modeled, and governance-equipped — that your organization can authorize and execute the day it arrives.
Edit failure rates average 7.2% vs 3.1% best practice. Recovery rates average 38% vs 71% best practice. NCCI violation rates 4.8% vs 1.4% best practice. SLA compliance 61% vs 94% best practice. FIFO queue management ensures $42,000 edit failures wait behind $42 edit failures every day.
This is the depth, rigor, and execution infrastructure of a Bain or McKinsey engagement — pre-built and available at a fraction of the cost. Every deliverable that a consulting team would spend weeks producing is already done. Your team deploys. Your Finance Partner confirms the returns. Your governance framework sustains the gains permanently.
These outcomes reflect the performance benchmarks embedded in the CEID Intelligence Dataset, calibrated against top-decile operational performance. Actual results will vary based on starting baseline and implementation execution.
Edit failure rate reduced to 3.5% or below
Recovery rate improved to 60–71%
NCCI violation rate reduced to 1.4%
SLA compliance above 92%
Financial impact scoring active at queue entry
Every financial figure is derived from the CEID Intelligence Dataset benchmark framework and the HOIP project financial models. Figures represent typical ranges for a mid-sized health system or health plan.
$2.4M in edit recovery improvement. $1.8M in denial prevention. $3.1M in financial impact maximization.
$640K in rework cost elimination. $480K in audit exposure reduction. $380K in operational waste reduction.
Edit productivity improved 34%. Workflow optimization. Capacity without additional FTE.
Every project follows the full DMAIC methodology: Define, Measure, Analyze, Improve, Control. Each project includes 10 deliverables — Project Charter, Executive A3, SIPOC, Current State Assessment, Root Cause Analysis, Financial Impact Workbook, Future State Design, Improvement Roadmap, Control Plan, and Executive Summary.
The HOIP Implementation Playbook provides a structured 365-day execution plan. Every milestone is defined. Every financial checkpoint is confirmed by the Finance Partner. Every control plan is activated before the team moves to the next initiative.
Days 1–14
Charter all 10 projects. Baseline all KPIs. Validate financial models with Finance Partner.
Days 15–30
Wave 1 projects at Improve phase. First financial captures confirmed.
Days 31–90
Wave 2 projects active. AI models deployed. 22–35% of Year 1 target captured.
Days 91–180
All 10 projects at Control phase. 55–65% of Year 1 target realized.
Days 181–365
Annual certification. Finance Partner confirms Year 1 contribution. Year 2 pipeline scoped.
The Master Governance Framework defines ownership, reporting cadence, escalation protocol, and benefits certification infrastructure. Every KPI has a named executive owner. Every threshold has an automatic escalation trigger. Every monthly review has a defined agenda and Finance Partner confirmation requirement.
Daily and weekly KPI dashboard review. Queue health checks. Process compliance audits. No executive involvement in routine operation.
Monthly Program Director-chaired review. KPI status, financial performance, escalation review, 30-day action plan confirmation.
Quarterly CFO/COO-level investment review. Portfolio financial confirmation. Escalation resolution. Year-ahead pipeline authorization.
Year-end Finance Partner benefits audit. Every claimed benefit traced to source data. Executive sponsor sign-off. Board-presentable confirmation report.
The Master Benefits Realization Tracker compares planned benefits to Finance Partner-confirmed actuals every month. Variance above 15% triggers Director review. Variance above 25% triggers CFO escalation. Every dollar claimed is traceable, non-duplicated, and auditable.
Benefits that cannot be confirmed are projections. Confirmed, auditable benefits are organizational facts. This program builds the confirmation infrastructure from Day 1 — so that every quarterly executive review and every annual board presentation rests on certified financial evidence, not estimates.
Organizations that authorize this program are not buying files or templates. They are buying the operational transformation infrastructure that eliminates the design phase entirely and compresses the time from executive authorization to financial results from months to days.
Every project has a Finance Partner-validated financial model with ROI, NPV, payback period, and 3-year cumulative value. You are not authorizing a hope. You are authorizing a structured financial investment with confirmed returns and an audit-ready benefits certification process.
Every project is pre-scoped, pre-designed, and pre-roadmapped. Your operations team deploys — they do not design. The governance framework is already built. The escalation protocol is already defined. Your role is authorization and oversight, not architecture.
This is the difference between a consulting engagement that takes 6 months to produce recommendations and a transformation program that is executing on Day 14. The DMAIC artifacts are already done. The root cause analysis is already scoped. The future state is already designed.
Deploy this program with your client and compress your engagement timeline from quarters to weeks. The analytical infrastructure, project design, financial models, and governance frameworks that typically consume half your engagement are already built. Focus on execution. Deliver results faster.
This program ships complete. Every master deliverable. Every project artifact. Every governance tool. Every financial model. Ready for immediate deployment.
This program is designed for executives, operational leaders, and transformation professionals who have authority over the operational domain it addresses.
The Intelligent Platforms Transformation Journey
One program. 10 projects. 114 files. Complete transformation infrastructure. Deploy immediately upon receipt.
Includes:
• 10 DMAIC improvement projects (all phases)
• 114 files — master deliverables + project artifacts
• Master Governance Framework
• Master KPI Library (10 benchmarked KPIs)
• Master Financial Impact Workbook
• Master Benefits Realization Tracker
• Master Executive Presentation (30 slides)
• Master Business Case
• Master Implementation Roadmap
• START HERE Executive Guide
• All 10 Control Plans (5-tab XLSX each)
• Commercial use license
The Claims Edit Prevention & Revenue Integrity HOIP is designed to work in concert with the CEID Intelligence Dataset. The dataset provides the record-level financial impact scoring, benchmark calibration, and priority ranking that populates the HOIP KPI baselines and financial models with your organization’s actual operational data.
Deploy the dataset first to establish intelligence baselines. Then execute the HOIP to convert those baselines into confirmed financial results.
View CEID Dataset