Issued September 26, 2023 — three business days before close on September 29. This is the final readiness assessment gate before cutover. All workstreams report status against go/no-go criteria. The decision to proceed to Day 1 operations is made Friday morning (September 29, close of business) after this report is finalized.
Integration Readiness Gate & Go/No-Go Criteria
Contents
1. Readiness Assessment Overview
The Day 1 Readiness Assessment evaluates eight workstreams against go/no-go criteria. Three criteria are required for a GO decision:
- Data integrity: All member data loads are complete and validated. Data quality issues are known and accepted (not hidden or deferred).
- System readiness: All critical systems (member management, claims, billing, enrollment, provider network) are operational and have completed parallel testing with real transactions.
- Operational readiness: All teams (support, billing, network operations) are staffed, trained, and ready to manage go-live operations for 24 hours post-close.
If any workstream cannot meet these criteria, the Day 1 decision escalates to the Steering Committee for a go/delay decision.
2. Workstream Readiness Summary
| Workstream | Lead | Status | Key Issue |
|---|---|---|---|
| 1. Member Identity & Data | Dr. A. Ravindran | GREEN | Rehearsal load executed twice in the isolated environment under Clean Team control. EMPI engine, blocking rules and thresholds validated against the permitted sample. Production load executes in the cutover window. |
| 2. Claims & Adjudication | W. Ferriday | GREEN | Claims migration complete for all in-flight claims. Parallel adjudication on sample set shows no systematic errors. Cutover window confirmed. |
| 3. Enrollment & Eligibility | R. Lattimore | GREEN | Enrollment file migration complete. Eligibility validation against benefits file shows 99.2% match. Discrepancies queued for steward review. |
| 4. Provider Network & Credentialing | F. Underhill | GREEN | Provider roster merge complete. Duplicate credentials resolved. Network file loaded and tested with sample referral queries. |
| 5. Billing & Invoicing | R. Cadwallader | YELLOW | GL mapping validation incomplete for 3% of revenue codes. These are low-volume items; plan to reconcile post-close. No revenue is at risk; audit trail is in place. |
| 6. Cloud Infrastructure (Azure IaaS) | B. Trammell | GREEN | Landing zone validated. All workloads staged and tested. Runbooks for failover scenarios rehearsed. DR failover drill successful on Schedule. |
| 7. Support Operations & Escalation | R. Lattimore | GREEN | Support team staffed for 24/7 coverage for Day 1. Runbooks and escalation paths validated. Member communication materials printed and ready for distribution. |
| 8. Vendor Coordination (TSA & Managed Services) | H. Castellow | GREEN | TSA handoff procedures finalized with G. Threadgill (Cheatham Mutual). All interim systems (host, EDI, claims attachments) confirmed operational through close window. |
Billing GL mapping discrepancy (Workstream 5): Three revenue codes (pharmacy rebates, direct mail campaigns, admin fees from commercial partners) have GL mappings that could not be validated against the target system's GL structure by the deadline. These items represent <0.5% of revenue and are not operationally critical for Day 1. The plan is to reconcile these post-close (Week 1) and make corrections with audit trail. This is acceptable because: (1) the accounts are not yet closed for either organization (the quarter runs through September 30), (2) no transaction will be lost, and (3) the mapping can be corrected with retrospective GL entries. However, this must be tracked and reported to the CFO as an open item.
3. Critical Path & Cutover Scenario
The cutover window runs from the scheduled close, Friday, September 29, 2023 at 5:00 PM ET, through the scheduled Day 1 market open on Monday, October 2, 2023 at 7:00 AM ET. This provides approximately 65 hours for cutover activities:
- Friday 5:00–10:00 PM: Final data validation and load of all remaining transactions from both legacy systems. Final reconciliation reports generated. Teams in place for overnight monitoring.
- Friday 10:00 PM–Saturday 6:00 AM: System shutdown of legacy member management systems. Final backup and data export completed. Integration layer receives the final unified member dataset. The deterministic match pass runs; records below that bar are held as separate records with duplicate-candidate flags and are not merged during the window.
- Saturday 6:00 AM–6:00 PM: Parallel cutover testing. A sample of member queries, claim submissions, and eligibility checks are run against the new integrated system. Results compared to legacy system outputs. All differences are explained and accepted or corrected.
- Saturday 6:00 PM–Sunday 8:00 AM: System handoff to production support. Final runbook reviews. All on-call personnel in place. Any outstanding data discrepancies escalated for emergency resolution.
- Sunday 8:00 AM–Monday 7:00 AM: Monitoring-only window. No changes permitted. Systems are observed for stability. Member helpline receives incoming calls (volume expected to be high) and support team logs all issues for prioritization post-open.
- Monday 7:00 AM: Market open and Day 1 operations begin. All teams report to their war rooms. Incident command structure activates. The program transitions from cutover mode to operations mode.
4. Go/No-Go Decision Criteria
| Criterion | GO Threshold | Current Status |
|---|---|---|
| Member data loads rehearsed and validated | Full-volume rehearsal load completes inside the window with reconciled record counts and no critical data loss | Two clean rehearsals at full volume (1.8M ACME + 420K CVHP). Counts reconcile. Production load is a cutover-window activity. |
| Data quality issues identified and accepted | All known defects logged, root causes documented, mitigation plans in place | All defects found in rehearsal are logged with root cause. EMPI volumes remain planned at the deal-model rates (65% deterministic, 27% probabilistic auto, 8% clerical review) — see the constraint note below. |
| Critical systems tested and operational | All go-live systems (member mgmt, claims, billing, enrollment) pass parallel testing with zero critical defects | All systems tested. Claims adjudication validated. One non-critical GL mapping issue (Workstream 5) accepted and tracked. |
| Cutover procedures validated | Runbooks rehearsed, timing validated, data migration tested, rollback procedures confirmed operational | Cutover window validated. DR drill successful. Rollback scenarios tested. |
| Support staffing and training complete | All support staff trained on Day 1 procedures, escalation paths validated, communication materials ready | 24/7 support team in place. Member materials prepared. Escalation drill completed. |
| Executive sponsorship and decision authority confirmed | Sponsor (D. Ashmore, CFO) confirms readiness and authorizes go-live | Pending Steering Committee sign-off (Friday Sept 29 morning) |
On the EMPI rates in criterion 2 — what this gate can and cannot certify. The 65/27/8 split is an assumption carried from the deal model, not a measurement. It cannot be verified before close: antitrust rules bar the acquirer from examining the target's member-level records, so every rehearsal to date has run against a Clean Team sample sized for engine validation, not for population statistics. What this gate certifies is that the matching engine works, the blocking rules perform, and the thresholds behave as specified. What it cannot certify is how many of Cumberland Valley's 420,000 members will actually land in each band. That number becomes knowable only after close, when the full file can be profiled. Readiness therefore means the mechanism is proven and the volume is still an estimate — and the steward capacity plan downstream of it inherits that uncertainty.
Overall readiness: GO (contingent on Steering Committee approval). All six critical criteria are met or will be met by Friday morning. The one outstanding item (Billing GL mapping) is tracked and does not block go-live. The program is operationally ready to execute cutover.
5. Day 1 Escalation & Contingency
Incident Command Structure (Day 1): A command center activates Monday morning with representatives from each workstream. The Program Manager (C. Tyrrell) chairs the incident command; the Executive Sponsor (D. Ashmore) has escalation authority. Issues are triaged into three categories:
- P1 (Severity 1): Operational outage or data integrity issue affecting member-facing services. Resolution time target: 2 hours. Escalates to Incident Commander immediately.
- P2 (Severity 2): Degraded service or workaround required, but system operational. Resolution target: 8 hours. Escalates to workstream lead; if not resolved in 4 hours, escalates to Incident Commander.
- P3 (Severity 3): Minor issue, cosmetic, or process-dependent. Resolution target: 24 hours. Workstream lead owns resolution; no escalation unless issue recurs.
Go/Delay Contingency: If a P1 issue emerges during the cutover window that cannot be resolved in 2 hours, the Incident Commander may invoke a delay scenario: rollback to legacy systems and postpone Day 1 operations by 24–48 hours. This decision requires Sponsor approval and Steering Committee notification. The TSA window accommodates one delay with no impact to schedule.
Related artifacts: 30 — Day 1 Go/No-Go Decision · 9 — Integration Management Plan · 26 — Quality Plan