The qualification engine. When to advance, pivot, or walk.
Every pipeline has the same disease: deals that should have been disqualified three months ago sitting at 60% probability because nobody had the framework to say "this isn't going to close." That's not a forecasting problem. That's a qualification problem.
This schema replaces gut-feel qualification with conditional logic. If the prospect meets condition X, then action Y. If they don't, action Z. No ambiguity. No "let's keep it warm and see." Either the conditions are met to advance, or they're not. And if they're not, you know exactly what needs to change before they are.
The best reps aren't the ones who close everything. They're the ones who know what to walk away from early, so they can invest time in the deals that actually close.
Four dimensions that shape every deal: ownership, level of care, payer mix, and size. Each dimension carries RCI modifiers that compound across the qualification engine.
The single most predictive variable for deal velocity, decision process, and messaging strategy. Eight archetypes, each with distinct buying DNA.
Primary Driver: EBITDA optimization
Timeline Pressure: 45 days
Key Personas: CFO, COO, PE Operating Partner
Discovery Flags: Board-mandated margin targets, platform acquisition integration, management company pressure
Primary Driver: Growth metrics
Timeline Pressure: 30 days
Key Personas: CEO, VP Growth, Board Observer
Discovery Flags: Series funding milestones, rapid census growth outpacing ops, investor reporting requirements
Primary Driver: Personal vision + cash flow
Timeline Pressure: 90 days
Key Personas: Owner (wears multiple hats), Office Manager
Discovery Flags: Founder burnout, wearing too many hats, "I do the billing myself" statements
Primary Driver: Enterprise alignment
Timeline Pressure: 180 days
Key Personas: VP Behavioral Health, CIO, CFO, Procurement
Discovery Flags: Enterprise standardization initiatives, EHR consolidation projects, service line P&L pressure
Primary Driver: Mission alignment + sustainability
Timeline Pressure: 120 days
Key Personas: Executive Director, CFO, Board Treasurer
Discovery Flags: Grant renewal cycles, board mandate for financial sustainability, revenue diversification pressure
Primary Driver: Access + quality metrics
Timeline Pressure: 90 days
Key Personas: CEO, CFO, Quality Director, IT Director
Discovery Flags: UDS reporting burden, HRSA compliance deadlines, sliding fee scale complexity
Primary Driver: Budget cycle + mandate
Timeline Pressure: 240 days
Key Personas: Department Director, County Administrator, Procurement Officer
Discovery Flags: Fiscal year budget alignment, board of supervisors approval required, RFP-driven process
Primary Driver: Legislative mandate
Timeline Pressure: 365 days
Key Personas: Agency Director, State CIO, Legislative Liaison, Procurement
Discovery Flags: Legislative session timing, state budget cycles, inter-agency coordination requirements
The level of care determines regulatory complexity, documentation requirements, and how well Kipu's platform fits the clinical workflow. Higher-acuity settings generate higher RCI base weights because the billing and compliance stakes are greater.
| Level of Care | ASAM Level | Regulatory Complexity | RCI Base Weight | Kipu Fit Score |
|---|---|---|---|---|
| Medically Managed Detox | 3.7 / 4.0 | High | 90 | 0.95 |
| OTP (Opioid Treatment Program) | 1-OTP | Very High | 85 | 0.90 |
| Residential | 3.1 / 3.3 / 3.5 | Moderate | 80 | 0.95 |
| PHP (Partial Hospitalization) | 2.5 | Moderate | 75 | 0.90 |
| IOP (Intensive Outpatient) | 2.1 | Low | 65 | 0.85 |
| Standard Outpatient | 1.0 | Low | 55 | 0.75 |
Payer mix determines billing complexity, revenue predictability, and the specific RCM pain points a prospect faces. Each payer composition type carries a distinct RCI modifier because the operational burden varies dramatically.
| Payer Composition | Identifier | RCI Modifier | Key Billing Challenges |
|---|---|---|---|
| Commercial Heavy (>60%) | PAY_COMM | 1.2x | Prior auth, concurrent review, credentialing |
| OON Primary | PAY_OON | 1.4x | SCA negotiation, patient collection, No Surprises Act |
| Medicaid Heavy (>60%) | PAY_MCAID | 0.8x | MCO variations, rate adequacy, timely filing |
| Medicare Heavy (>40%) | PAY_MCARE | 0.9x | Medical necessity, LCD/NCD, RAC exposure |
| Private Pay Primary | PAY_CASH | 1.0x | Payment plans, good faith estimates, scholarship tracking |
| Mixed / Hybrid | PAY_HYB | 1.1x | Multiple workflow management, staff training burden |
Size determines decision complexity, implementation scope, and the number of stakeholders involved. Larger organizations have higher deal values but slower decision cycles and more complex procurement processes.
| Size Category | Identifier | Locations | RCI Modifier | Decision Speed |
|---|---|---|---|---|
| Single Site | SIZE_1 | 1 | 0.8x | Fast |
| Multi-Site Small | SIZE_2_5 | 2–5 | 1.0x | Moderate |
| Multi-Site Medium | SIZE_6_15 | 6–15 | 1.3x | Slow |
| Enterprise | SIZE_16_PLUS | 16+ | 1.5x | Very Slow |
Nine personas across three groups. Each group requires a distinct methodology. The wrong approach to the wrong persona kills deals before they start.
Executives respond to insight, not information. Lead with a provocation, back it with data, and connect to their strategic reality.
Concerns: Strategic growth, financial performance, organizational reputation, board/investor accountability
Methodology: Challenger — teach, tailor, take control
Opening: "What's keeping you up at night about your revenue cycle?"
Focuses on the strategic horizon. Doesn't want operational details — wants to know the business impact.
Concerns: Cash flow, days in AR, denial rates, cost-to-collect, margin erosion
Methodology: Challenger — reframe with financial benchmarks
Opening: "Walk me through your current days in AR and how that's trending."
Speaks in numbers. Bring benchmarks. If you can't quantify it, don't say it.
Concerns: Operational efficiency, staff productivity, process standardization, scalability
Methodology: Challenger — expose hidden operational cost
Opening: "How much time is your team spending on rework and manual workarounds?"
Process-oriented. Wants to see workflow impact, not features. Show the before and after.
Clinical personas are skeptical of vendor promises and protective of their teams. Use Motivational Interviewing (OARS: Open questions, Affirmations, Reflections, Summaries) blended with Challenger insights on documentation best practices.
Concerns: Documentation burden, clinician burnout, clinical quality metrics, regulatory compliance
Methodology: MI-Challenger Hybrid — OARS framework
Opening: "Help me understand what a typical day looks like for your clinical team."
The gatekeeper of clinical workflow. If you alienate this persona, you lose the clinical champion.
Concerns: Medical necessity documentation, peer review defense, utilization review, clinical integrity
Methodology: MI-Challenger Hybrid — evidence-based positioning
Opening: "When you get a medical necessity denial, what does the appeal process look like?"
Physician-level conversation. Speak to clinical evidence, not billing mechanics.
Concerns: Medication administration, MAR compliance, nursing documentation, shift handoff accuracy
Methodology: MI-Challenger Hybrid — safety and compliance focus
Opening: "What does medication administration documentation look like on a busy night?"
Patient safety is the lens. Every feature must connect to safer, more compliant care.
Operational personas live in the weeds. They know every broken process and workaround. Respect their expertise, then show them what's possible.
Concerns: Audit readiness, regulatory risk, documentation gaps, accreditation standards
Methodology: Risk-led Consultative Challenger
Opening: "If a payer audited your last 50 charts tomorrow, what would they find?"
Fear of audit is the most powerful motivator. Use it ethically but directly.
Concerns: Claim submission accuracy, denial management, staff training, AR follow-up backlog
Methodology: Operational-led Consultative Challenger
Opening: "Walk me through what happens when a claim gets denied."
This person feels the pain every day. Acknowledge it before you solve it.
Concerns: Integration architecture, data security, system reliability, vendor management overhead
Methodology: Architecture-led Consultative Challenger
Opening: "What does your current integration architecture look like?"
Speaks in APIs and uptime. Show technical competence or lose credibility immediately.
Six master rules that route deals to the right track based on dimensional analysis. Each rule fires when its trigger conditions are met.
Trigger: PE-Backed (FP_PE) + OON Primary (PAY_OON) + Boutique Residential
| Trigger Condition | Value | Weight |
|---|---|---|
| Ownership | FP_PE | Urgency 1.3x |
| Payer Mix | PAY_OON | RCI 1.4x |
| Level of Care | Residential (3.1/3.5) | Base Weight 80 |
RCI Weighting Adjustments: Revenue leakage weight +20%, denial risk weight +15%. Lead with SCA negotiation ROI and denial recovery metrics. CFO/COO dual-track engagement.
Trigger: Nonprofit (NP_501) + Medicaid Heavy (PAY_MCAID) + OTP
| Trigger Condition | Value | Weight |
|---|---|---|
| Ownership | NP_501 | Urgency 0.6x |
| Payer Mix | PAY_MCAID | RCI 0.8x |
| Level of Care | OTP (1-OTP) | Base Weight 85 |
RCI Weighting Adjustments: Compliance exposure weight +25%, documentation gap weight +20%. Lead with regulatory risk reduction and MCO variation management. Mission-aligned messaging mandatory.
Trigger: Multi-Site (SIZE_6_15) + PHP/IOP + Commercial Payer Mix
| Trigger Condition | Value | Weight |
|---|---|---|
| Size | SIZE_6_15 | RCI 1.3x |
| Level of Care | PHP (2.5) / IOP (2.1) | Base Weight 65–75 |
| Payer Mix | PAY_COMM | RCI 1.2x |
RCI Weighting Adjustments: Operational inefficiency weight +30%, revenue leakage weight +10%. Lead with cross-site standardization, centralized reporting, and prior auth automation. COO is primary persona.
Trigger: Health System (FP_HS) + Any Payer Mix + Any LOC
| Trigger Condition | Value | Weight |
|---|---|---|
| Ownership | FP_HS | Urgency 0.5x |
| Size | SIZE_16_PLUS (typical) | RCI 1.5x |
| Decision Process | Committee-based | Timeline 180+ days |
RCI Weighting Adjustments: All weights normalized. Lead with enterprise integration architecture, HL7/FHIR capabilities, and service line P&L impact. Requires internal champion strategy.
Trigger: Owner-Operator (FP_OO) + Single Site (SIZE_1) + Any Payer Mix
| Trigger Condition | Value | Weight |
|---|---|---|
| Ownership | FP_OO | Urgency 0.8x |
| Size | SIZE_1 | RCI 0.8x |
| Decision Process | Single decision-maker | Timeline 90 days |
RCI Weighting Adjustments: Operational inefficiency weight +25%, documentation gap weight +15%. Lead with "get your life back" messaging — time savings, reduced billing stress, personal bandwidth recovery.
Trigger: Government (GOV_CTY or GOV_ST) + Any Configuration
| Trigger Condition | Value | Weight |
|---|---|---|
| Ownership | GOV_CTY or GOV_ST | Urgency 0.2x–0.3x |
| Decision Process | RFP / Procurement | Timeline 240–365 days |
| Budget Cycle | Fiscal year alignment | Hard constraint |
RCI Weighting Adjustments: Compliance exposure weight +30%, all other weights deprioritized. Lead with mandate compliance, audit trail, and public accountability reporting. RFP response capability is table stakes.
Each stage has hard requirements. Meet them or don't advance.
Prospecting → Discovery
| Condition | Required? | If No |
|---|---|---|
| Prospect matches Tier 1 or Tier 2 ICP criteria | Yes | Move to Tier 3 evaluation or disqualify |
| Decision-maker identified (title + name) | Yes | Research further. Cannot advance without DM. |
| Prospect has insurance billing (not 80%+ private pay) | Yes | Hard disqualify — no RCM need |
| Census ≥ 20 patients or growth trajectory confirmed | Yes | Too small. Park and revisit in 6 months. |
| No failed Kipu implementation in last 18 months | Yes | Hard disqualify. Relationship remediation needed first. |
All conditions must be met. One "No" blocks advancement.
Discovery → Solution Presentation
| Condition | Required? | If No |
|---|---|---|
| Specific revenue cycle pain point articulated by prospect | Yes | Re-run discovery. Educate with benchmarks. If still no pain after 2nd call, disqualify. |
| Current billing process mapped (in-house, outsourced, hybrid) | Yes | Cannot build solution narrative without this. Schedule follow-up. |
| Clinical documentation readiness assessed (green/yellow/red) | Yes | If red: recommend EMR remediation. Pause RCM pursuit. |
| EMR identified + integration pathway clear | Yes | Schedule technical validation call with IT stakeholder. |
| Budget conversation initiated (not resolved, initiated) | Preferred | Can advance, but flag as risk. Must resolve by S3. |
4 of 5 required. Budget can carry to next stage but must be addressed.
Solution Presentation → Proposal
| Condition | Required? | If No |
|---|---|---|
| Demo/presentation delivered to decision-maker (not just evaluator) | Yes | Must get DM in the room. Reschedule. |
| Prospect confirms solution addresses their stated pain point | Yes | Misalignment. Re-discovery or pivot approach. |
| Technical feasibility confirmed (IT sign-off or no IT blocker) | Yes | Schedule technical deep-dive. Cannot propose without this. |
| Budget range discussed and within feasibility | Yes | If budget doesn't exist: ROI business case needed. Extends timeline 30-60 days. |
| Implementation timeline discussed | Preferred | Can advance, but proposal should include timeline options. |
| Competitive alternatives identified | Preferred | Assume competition exists. Position proactively. |
First 4 required. Last 2 preferred but not blocking.
Proposal → Contract / Close
| Condition | Required? | If No |
|---|---|---|
| Proposal reviewed by decision-maker | Yes | Confirm DM has seen it. Not just forwarded — reviewed. |
| Verbal or written intent to proceed | Yes | If "still evaluating" after 2 weeks: re-engage with new information or urgency trigger. |
| Legal/compliance review initiated | Yes | For hospital/state: expect 30-60 day legal review. Plan accordingly. |
| Implementation start date tentatively agreed | Preferred | Commitment without timeline = soft commitment. Push for date. |
| BAA and security documentation exchanged | Yes | Cannot close without BAA. Send proactively. |
All required conditions must be met. No exceptions for contract stage.
Revenue Cycle Intelligence score quantifies the prospect's RCM pain and Kipu's ability to address it. Every deal gets a number, not a feeling.
Each component is scored 0–100 independently. Weights are adjusted by the dimensional modifiers from ownership, LOC, payer mix, and size. The weighted sum produces the composite RCI score.
| RCI Score | Classification | Action |
|---|---|---|
| 80–100 | Critical | Immediate engagement. Fast-track to demo. Revenue is actively leaking. |
| 60–79 | High | Priority pursuit. Full discovery cycle. Strong ROI case available. |
| 40–59 | Moderate | Standard pipeline. Requires education to elevate urgency. |
| 20–39 | Low | Nurture sequence. Not ready for active pursuit. |
| 0–19 | Minimal | Disqualify or long-term nurture. No immediate opportunity. |
| Dimension | Modifier Source | Impact |
|---|---|---|
| Ownership | urgency_multiplier | Scales timeline weighting |
| Ownership | deal_size_multiplier | Adjusts revenue leakage weight |
| Level of Care | RCI base weight | Sets baseline complexity |
| Level of Care | Kipu fit score | Adjusts solution confidence |
| Payer Mix | RCI modifier | Scales billing complexity |
| Organization Size | RCI modifier | Scales operational scope |
A PE-backed (1.3x urgency, 1.5x deal size), multi-site medium (1.3x), OON-heavy (1.4x) residential facility with an RCI base weight of 80:
This is your highest-priority deal archetype. Every hour spent on lower-RCI deals instead of this one is revenue left on the table.
Kipu EMR customers are not the same as new logos. The relationship is established. The data is accessible. The approach must reflect that.
Must have:
Disqualifiers:
For existing customers, discovery is shorter and data-informed. You already have access to:
Lead with: "We've been looking at your data and noticed some patterns that suggest you might be leaving revenue on the table. Can we walk through what we're seeing?"
For new logos, the pitch is "Kipu RCM is the best solution." For existing customers, the pitch is fundamentally different:
"You already trust Kipu with your clinical data. RCM is the natural extension — one platform, one data set, no integration headaches. Every other RCM vendor has to build the bridge to your EMR. We're already there."
Key differentiators for existing customers: zero integration cost, real-time clinical-to-billing data flow, single vendor accountability, and faster implementation (30-45 days vs. 60-90 for new logos).
| Factor | Modifier | Rationale |
|---|---|---|
| Existing Kipu EMR customer | +15% RCI boost | Integration advantage reduces implementation risk and accelerates ROI realization |
| Multi-product customer (EMR + another module) | +10% RCI boost | Demonstrated platform commitment reduces churn risk |
| High EMR utilization (>80% feature adoption) | +10% RCI boost | Clinical documentation maturity predicts RCM readiness |
| Low EMR utilization (<40% feature adoption) | -10% RCI penalty | Underlying adoption issues will carry into RCM |
| Active support escalation | -20% RCI penalty | Relationship risk. Must resolve before RCM pursuit. |