Hospitals across the US negotiate agreements with insurers that dictate how they get paid for procedures. A mid-size hospital maintains dozens of these contracts, each hundreds to thousands of pages of negotiated rates and carveouts, plus additional amendments, one-off payor policies, etc. They live in a SharePoint or network folder someone set up years ago, with filenames like FINAL_V2_use_this_one, with minimal if any documentation, sometimes long lost to a prior colleague. They are not connected to the billing systems that process claims and payments. The result is crippling capital leak, with hospitals losing up to 10% of net revenue annually to inaccurate payments. Cue the Battle of the Bots: payors have begun to deploy AI that denies within seconds; providers have countered with agents that appeal and re-code. It is an arms race built on top of a big soup of word documents and pdfs with inherent conflicts and inaccuracies.

Enter Kubera Health, the missing infrastructure layer between the agreements that govern payment and the systems that execute them. Founder and CEO Roja Garimella, MD, MBA is the rare clinician turned entrepreneur who understands the human and business of healthcare. She resonates with doctors and patients, hospital CFOs and payor execs alike. With just product mockups, she was getting in front of dozens of hospital and payor leaders, convincing them to be design partners. We are thrilled to partner with Roja and team and lead the $6.5M seed round, alongside our good friends at Company Ventures, Dria Ventures, and SemperVirens.

The Kubera platform starts by ingesting an organization's entire contract portfolio. The platform parses documents into structured reimbursement logic: per-diem rates, multi-procedure discounting rules, carveouts that only apply to specific CPT code ranges, etc. With this information, Kubera’s Payment Auditing tool works continuously rather than as a quarterly look-back. As remittances come in, every payment gets checked against the contract rules. Discrepancies get flagged with the specific contractual term attached for review. If a payor is systematically underpaying on a particular code, that shows up as a trend rather than a series of missed one-off exceptions.

The Contract Modeler works the other direction. Before a contract renewal, teams can pull their actual claims history and run scenarios like “What happens to revenue if we move reimbursement from 120% to 150% of Medicare? What's the dollar impact of accepting the payor's proposed stop-loss change?” These are questions managed care teams have always wanted to answer but could never get the answers to because contract terms lived in a PDF, the claims data lived in the billing system, and the fee schedules lived in a spreadsheet someone on finance maintained.

We spent a ton of time during diligence talking to managed care leaders about the pain points Kubera identified. Everyone spoke to some version of a shared, broken reality: payment discrepancies caught months late if at all, subpar renewals, and never enough people to fix all this. By the end of nearly every conversation the question wasn't whether they needed this product, it was how soon they could speak to the team. $3B of payments processed and 100% customer expansion later, Kubera is truly starting to scale.

At Upfront, we’re particularly excited by the unsexy infrastructure layer, one that if built makes you wonder how an industry ever functioned without it. Kubera is that missing infrastructure for healthcare payments. If you're a finance executive or managed care leader at a health system looking for a solution beyond just more people, or an engineer who wants to build the financial infrastructure for one of the largest industries on earth, reach out at kuberahealth.com.