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The financial infrastructure behind every healthcare contract

The financial infrastructure behind every healthcare contract

The financial infrastructure behind every healthcare contract

Continuous payment monitoring, stronger negotiations, and complete visibility into every payor-provider contract.

Continuous payment monitoring, stronger negotiations, and complete visibility into every payor-provider contract.

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Hidden financial impact

Most organizations are operating

with a fundamental blind spot.

Most organizations are leaving

significant revenue behind

Payor contracts are dense, unstructured, and disconnected from your data

Claim #…
Claim #39…
Claim #8921A

Billions lost to contract complexity and payment inaccuracy

Billions lost to contract complexity

and payment inaccuracy

Healthcare organizations on both sides of the payor-provider relationship lose billions annually to contract complexity because no system connects agreement terms to what was actually paid.

Healthcare organizations on both sides of the payor-provider relationship lose billions annually to contract complexity because no system connects agreement terms to what was actually paid.

Healthcare organizations on both sides of the payor-provider relationship lose billions annually to contract complexity because no system connects agreement terms to what was actually paid.

Claim #…
Claim #39…
Claim #8921A
BlueCross Contracting
Proposal denied
Please find attached our model requesting a +10% rate increase across major outpatient codes to offset rising costs.
2024_Rate_Model_v4.xlsxManual calculations
Request denied.Our benchmark data platform shows your facility is already pacing 12% above the regional median. We cannot approve increases based on manual spreadsheet models.

Every renewal starts with

an information deficit

Every renewal starts with

an information deficit

Without contract performance history and payment variance data, both sides enter renewals without a clear picture of how agreements are actually performing, so decisions get made on incomplete information.

Without contract performance history and payment variance data, both sides enter renewals without a clear picture of how agreements are actually performing, so decisions get made on incomplete information.

Without contract performance history and payment variance data, both sides enter renewals without a clear picture of how agreements are actually performing, so decisions get made on incomplete information.

Without contract performance history and payment variance data, both sides enter renewals without a clear picture of how agreements are actually performing - and decisions get made on incomplete information.

BlueCross Contracting
Proposal denied
Please find attached our model requesting a +10% rate increase across major outpatient codes to offset rising costs.
2024_Rate_Model_v4.xlsxManual calculations
Request denied.Our benchmark data platform shows your facility is already pacing 12% above the regional median. We cannot approve increases based on manual spreadsheet models.
RCRevenue Cycle
CPT 70405$1,150.00
Billing_System_Export.csv
FTFinance Team
CPT 70405$1,150.00
Q3_Forecast_Model.xlsx
MCManaged care
CPT 70405$1,250.00
Contract_Amendment_vFINAL.pdf

Disconnected data makes contract performance invisible to everyone

Disconnected data makes contract performance invisible to everyone

Disconnected data makes contract

performance invisible to everyone

Contract files, claims data, and payment reports live in separate systems across separate teams. No one has the full picture of what payor-provider contracts are actually delivering.

Contract files, claims data, and payment reports live in separate systems across separate teams. No one has the full picture of what payor-provider contracts are actually delivering.

RCRevenue Cycle
CPT 70405$1,150.00
Billing_System_Export.csv
FTFinance Team
CPT 70405$1,150.00
Q3_Forecast_Model.xlsx
MCManaged care
CPT 70405$1,250.00
Contract_Amendment_vFINAL.pdf
RCRevenue Cycle
CPT 70405$1,150.00
Billing_System_Export.csv
FTFinance Team
CPT 70405$1,150.00
Q3_Forecast_Model.xlsx
MCManaged care
CPT 70405$1,250.00
Contract_Amendment_vFINAL.pdf

Our Solution

Contract complexity, solved

in one connected system

Contract complexity, solved

in one connected system

End-to-end contract & payment intelligence

Contract complexity, solved

in one connected system

Ingestion

Every contract term, structured and computable

Every contract term, structured and computable

Every contract term, structured

and computable

Every contract term,

structured and computable

Kubera ingests every contract, amendment, and fee schedule - turning complex documents into structured logic where every rate and rule is queryable.

Kubera ingests every contract, amendment, and fee schedule - turning complex documents into structured logic where every rate and rule is queryable.

Kubera ingests every contract, amendment, and fee schedule - turning complex

documents into structured logic where every rate and rule is queryable.

Kubera ingests every contract, amendment,

and fee schedule - turning complex documents into

structured logic where every rate and rule is queryable.

Claims Timely Filing
90 days→365 days
Stop-loss limit
$25,000→$50,000
Termination notice
30 days→90 days

Modeling

Payment expectations grounded in actual contract logic

Payment expectations grounded in actual contract logic

Payment expectations grounded in actual contract logic

Payment expectations grounded

in actual contract logic

Kubera calculates expected payment for every claim using your actual contract rates, adjustments, and payment logic - and models term change impact before renewals.

Kubera calculates expected payment for every claim using your actual contract rates, adjustments, and payment logic - and models term change impact before renewals.

Kubera calculates expected payment for every claim

using your actual contract rates, adjustments, and payment

logic - and models term change impact before renewals.

Market benchmarkMS-DRG 470
Market 25th$13,500
Your Current Rate-11% To Market$12,000
Market Median$15,200
Simulation: Match median
+$0.00Mest. impact

Monitoring

Continuous payment monitoring, not quarterly reconciliation

Continuous payment monitoring,

not quarterly reconciliation

Continuous payment monitoring, not quarterly reconciliation

Continuous payment monitoring,

not quarterly reconciliation

Every payment compared against contract requirements, continuously. Each discrepancy classified by type and prioritized automatically.

AI agents classify underpayment drivers, prioritize follow‑up, and assist recovery turning revenue leakage detection from a quarterly exercise into

a continuous process

AI agents classify underpayment drivers, prioritize follow‑up, and assist recovery turning revenue leakage detection from a quarterly exercise into a continuous process

Every payment compared against contract requirements, continuously.

Each discrepancy classified by type and prioritized automatically.

Every payment compared against contract requirements,

continuously. Each discrepancy classified by type

and prioritized automatically.

Expected RevenueActual PaymentVariance
$120,048,870$111,772,508$8,276,363
$53,906,175$54,687,551-$781,376
$6,625,229$35,241,702-$28,616,473
$47,320,000$44,481,600$2,838,400
$32,750,000$34,070,000-$1,320,000
$28,400,000$26,180,000$2,220,000
$120,048,870$111,772,508$8,276,363
$53,906,175$54,687,551-$781,376
$6,625,229$35,241,702-$28,616,473
$47,320,000$44,481,600$2,838,400
$32,750,000$34,070,000-$1,320,000
$28,400,000$26,180,000$2,220,000

Intelligence

Every contract question answered. Every policy change, caught.

Every contract question answered. Every policy change, caught.

Every contract question answered. Every policy change, caught.

Every contract question answered.

Every policy change, caught.

Ask anything across your contract portfolio and get answers backed by actual agreement data. Mid-year policy changes surfaced before they create disputes.

Ask anything across your contract portfolio and get answers backed by actual agreement data. Mid-year policy changes surfaced before they create disputes.

Ask anything across your contract portfolio and get

answers backed by actual agreement data. Mid-year

policy changes surfaced before they create disputes.

Summarize this policy
What is the reimbursement process for DME claims exceeding $750?
What are the coverage limits for durable medical equipment (DME) under this policy?
Are there any exceptions to the $750 coverage limit for DME?
Ask any document related question...

In Their Words

The system they'd been looking for

The system they'd been looking for

The system they'd been looking for

“ We’ve wanted to assess performance of our programs and contracts but don’t have systems to help us. Kubera is the first we’ve seen that can pull in many data sources, serve as a source of truth, and help our teams uncover revenue opportunities.

VP of Managed Care · Southeast Regional Health System

“ We needed a hub for all our contracts and fee schedules — a place where we could see if payors were actually staying within their contracted guidelines. That used to be impossible without a tool like this.

VP of Managed Care · Southeast Regional Health System

“ We needed a hub for all our contracts and fee schedules — a place where we could see if payors were actually staying within their contracted guidelines. That used to be impossible without a tool like this.

VP of Managed Care · Southeast Regional Health System

Who We Serve

Two sides of the same broken system

Two sides of the same broken system

Two sides of the same broken system

Providers

You know what you were paid.
You don't know what you were owed.

You know what you were paid.
You don't know what you were owed.

Reconciling payments against complex contract terms is too manual to do consistently. Underpayments go undetected. Renewals happen without the data

to push back.

Reconciling payments against complex contract terms is too manual to do consistently. Underpayments go undetected. Renewals happen without the data to push back.

Managed Care & Contracting Leaders

Managed Care & Contracting Leaders

Revenue Cycle Leaders

Revenue Cycle Leaders

Revenue Integrity Teams

Revenue Integrity Teams

Finance & Accounting

Finance & Accounting

Learn More

Learn More

Providers

You know what you were paid.
You don't know what you were owed.

Reconciling payments against complex contract terms is too manual to do consistently. Underpayments go undetected. Renewals happen without the data to push back.

Managed Care & Contracting Leaders

Revenue Cycle Leaders

Revenue Integrity Teams

Finance & Accounting

Learn More

Payors

You manage hundreds of provider contracts. Most aren't fully visible.

You manage hundreds of provider contracts.

Most aren't fully visible.

You manage hundreds of provider contracts. Most aren't fully visible.

Provider networks grow. Contract complexity compounds. Without structured contract intelligence, enforcing agreement terms accurately at scale becomes impossible.

Provider Network & Contracting Leaders

Provider Network & Contracting Leaders

Finance & Claims Operations

Finance & Claims Operations

Learn More

Learn More

How it works

From contract document

to revenue action

From contract document to revenue action

From contract document

to revenue action

From contract document

to revenue action

Ingest & Structure

Ingest & Structure

Ingest & Structure

EXHIBIT A: COMPENSATION SCHEDULE

COMMERCIAL MANAGED CARE AGREEMENT

1. INPATIENT SERVICES

1.1 Base Compensation. Subject to the terms and conditions of this Agreement, Payor shall compensate Facility for Covered Services provided to Members at the negotiated Base Rate. For Medical/Surgical admissions, the per-diem rate is established at $4,500 per encounter01, regardless of the length of stay, unless otherwise specified in Section 1.2.

1.2 Stop-Loss Provision. In the event that Billed Charges for a single continuous Inpatient admission exceed the established threshold of $75,000, the reimbursement methodology shall revert to a percentage of Billed Charges. For any such outlier cases, Payor shall reimburse Facility at the Base Rate plus 65% of Billed Charges in excess of the threshold amount.

2. OUTPATIENT SERVICES

2.1 Fee Schedule. Outpatient surgical procedures shall be reimbursed according to the attached Ambulatory Payment Classification (APC) fee schedule. Multiple procedures performed during the same operative session are subject to standard unbundling logic (100% for the primary procedure, 50% for secondary procedures).

02

1. Rate Extraction: The model identified the primary reimbursement logic from Exhibit A. The negotiated per-diem rate is confirmed at 01 $4,500 per encounter, applied to Medical/Surgical admissions.

2. Carveout & Thresholds: Outlier payment logic extracted from §1.2. The stop-loss threshold is set at 02 $75,000; reimbursement reverts to 65% of Billed Charges above the threshold.

Connect contracts, rate exhibits, amendments, and payor policy documents. Kubera maps every pricing and operational term into structured, queryable fields.

Connect contracts, rate exhibits, amendments, and payor policy documents. Kubera maps every pricing and operational term into structured, queryable fields.

Build the Rule Engine

Build the Rule Engine

Build the Rule Engine

Rules & Settings0 active1 active2 active
Lesser of Billed Charges
Exclude from Stop Loss
Sequestration2% IP / 1.6% OP reduction
Multi-Procedure Logic
Tier percentages
Rank 1100%

Configure reimbursement logic carveouts, modifiers, VBC capitation rules and validate against historical claims before going live.

Configure reimbursement logic carveouts, modifiers, VBC capitation rules and validate against historical claims before going live.

Monitor & Detect

Monitor & Detect

Current Contractmonitoring1 detected2 detected
CodeCategoryAnnual CountCurrent RuleCurrent Rate
J2405Injections2,000150% of Medicare$155.36
J2406Injections1,240150% of Medicare$98.40
J1650Injections3,400120% of Medicare$42.75
J1756Infusions850150% of Medicare$215.60
J1642Injections1,820100% of Medicare$18.25
J7686Injections620150% of Medicare$312.18
J3489Infusions2,180130% of Medicare$76.45
J0696Injections950150% of Medicare$44.20
J9070Injections1,540110% of Medicare$128.90
J0290Injections740150% of Medicare$54.80
J2405Injections2,000150% of Medicare$155.36
J2406Injections1,240150% of Medicare$98.40
J1650Injections3,400120% of Medicare$42.75
J1756Infusions850150% of Medicare$215.60
J1642Injections1,820100% of Medicare$18.25
J7686Injections620150% of Medicare$312.18
J3489Infusions2,180130% of Medicare$76.45
J0696Injections950150% of Medicare$44.20
J9070Injections1,540110% of Medicare$128.90
J0290Injections740150% of Medicare$54.80

Connect your 835/837 data. Kubera continuously compares expected vs. actual payments and surfaces underpayments in a prioritized recovery queue.

Connect your 835/837 data. Kubera continuously compares expected vs. actual payments and surfaces underpayments in a prioritized recovery queue.

Model & Negotiate

Model & Negotiate

Scenario Summary
2024 Medicare, Jan 01, 2023 - Jun 30, 2023
Financial Impact
+$0.00(+0.0%)
Code Coverage
0.0%0 of 32 codes modified
GroupImpact
Injections+$82,500 (+20.0%)
J2405 - Ondansetron HCl+$62,140 (+20.0%)
J2406 - Aloxi+$17,525 (+20.0%)
J1650 - Enoxaparin sodium+$8,325 (+20.0%)

Use contract performance data and scenario modeling to quantify your negotiation leverage going into every renewal.

Use contract performance data and scenario modeling to quantify your negotiation leverage going into every renewal.

Model & Negotiate

Scenario Summary
2024 Medicare, Jan 01, 2023 - Jun 30, 2023
Financial Impact
+$0.00(+0.0%)
Code Coverage
0.0%0 of 32 codes modified
GroupImpact
Injections+$82,500 (+20.0%)
J2405 - Ondansetron HCl+$62,140 (+20.0%)
J2406 - Aloxi+$17,525 (+20.0%)
J1650 - Enoxaparin sodium+$8,325 (+20.0%)

Use contract performance data and scenario modeling to quantify your negotiation leverage going into every renewal.

Impact

Measurable outcomes

from contract and payment intelligence

The numbers that matter to your CFO

Measurable outcomes from contract and payment intelligence

$1M+

$1M+

$1M+

identified in contract improvements and payment inaccuracies in year one.

identified in contract improvements and payment inaccuracies in year one.

identified in contract improvements and payment inaccuracies in year one.

12 mo trailing

100%

100%

100%

of renewals backed by real contract performance data.

of renewals backed by real contract

performance data.

of renewals backed by real contract performance data.

of renewals backed by real contract performance data.

RC

F

MC

across 3 teams / wk

RC

F

MC

across 3 teams / wk

RC

F

MC

across 3 teams / wk

10+ hours

10+ hours

10+ hours

reclaimed per organization every week through a single source of truth.

reclaimed per organization every week through a single source of truth.

reclaimed per organization every week through a single source of truth.

$235,338

owed

$253,752

90 days

90 days

90 days

from contract ingestion to live payment monitoring. No IT lift required.

From contract ingestion to live payment monitoring no heavy IT lift required.

From contract ingestion to live payment monitoring no heavy IT lift required

From contract ingestion to live payment monitoring no heavy IT lift required

INGEST

MODEL

LIVE

“ Kubera paid for itself five times over in the first month. We identified three negotiation opportunities and an underpayment trend we didn't know existed.

“ Kubera paid for itself five times over in the first month. We identified three negotiation opportunities and an underpayment trend we didn't know existed.

“ Kubera paid for itself five times over in the first month. We identified three negotiation opportunities and an underpayment trend we didn't know existed.

Director of Revenue Cycle · Regional Health System

Director of Revenue Cycle · Regional Health System

“ Kubera paid for itself five times over in the first month. We identified three negotiation opportunities and an underpayment trend we didn't know existed.

Director of Revenue Cycle · Regional Health System

“ We used to spend two months on reporting every cycle. Kubera condensed the whole thing into two clicks.

“ We used to spend two months on reporting every cycle. Kubera condensed the whole thing into two clicks.

“ We used to spend two months on reporting every cycle. Kubera condensed the whole thing into two clicks.

National Hospital Network

National Hospital Network

“ We used to spend two months on reporting every cycle. Kubera condensed the whole thing into two clicks.

National Hospital Network

Security

Scale with security

Kubera is fully secure & compliant

Scale with security

Kubera is fully secure & compliant

Scale with security

Kubera is fully secure & compliant

Enterprise-grade security

Enterprise-grade security

Your data stays yours—always. Work with an AI platform that never trains on your PHI data. 

Your data stays yours—always. Work with an AI platform that never trains on your PHI data. 

Your data stays yours—always. Work with an AI platform that never trains on your PHI data. 

HIPAA

HIPAA

HIPAA

SOC2

SOC2

SOC2

  • ✓ BAA Support

    ✓ BAA Support

  • ✓ Modern & secure practices

    ✓ Modern & secure practices

  • ✓ Audit logs

    ✓ Audit logs

  • ✓ Encrypted end-to-end

    ✓ Encrypted end-to-end

  • ✓ No training on PHI

    ✓ No training on PHI

  • ✓ Modern & secure practices

    ✓ Modern & secure practices

  • ✓ BAA Support

    ✓ BAA Support

Enterprise-grade security

Your data stays yours—always. Work with an AI platform that never trains on your PHI data. 

HIPAA

SOC2

  • ✓ BAA Support

  • ✓ Modern & secure practices

  • ✓ Audit logs

  • ✓ Encrypted end-to-end

  • ✓ No training on PHI

  • ✓ Modern & secure practices

  • ✓ BAA Support

Providers

Payors

Join Us

Request a demo

Request a demo

Copyright © Kubera Health

admin@kuberahealth.com

admin@kuberahealth.com

Email

Address

33 Irving Place, Floor 5

New York, New York 10003

33 Irving Place

New York, New York 10003

33 Irving Place

New York, New York 10003

Copyright © Kubera Health

admin@kuberahealth.com

Email

Address

33 Irving Place

New York, New York 10003