Kubera Marketing Team
Today’s Problems
We see Managed Care and Revenue Cycle teams everywhere whose workflows are still painfully manual. Tasks like creating reports, tracking variances, making sense of benchmarking data, and contract negotiation preparation can take teams weeks and months when it should be a fraction of that. In a world constantly adapting from AI we feel it's time that these underappreciated departments receive the same treatment as many others already do in healthcare.
Improved Contract Matrices
Nowadays most contract repositories are stale the second a new amendment lands and too many teams still rely on manually updated excels or physical file cabinets. We’ve seen this create a constant workflow burden that limits what teams can confidently rely on and open the door to inaccuracies. Instead, Kubera automatically structures your entire payor contract portfolio and every business rule inside them in a live and easily queryable contract repository. So new contracts are automatically filed after a simple upload in a system that allows for portfolio-wide searches by payor, line of business, location, attribute, or code.
On-Demand Contract Modeling
Again, most managed care teams depend on very limited internal teams to model changes to their contracts if they even have the capacity to do that. With contract terms structured, managed care teams can now see how rate or methodology changes will affect their bottom line in a matter of minutes. Kubera offers this insight on demand if a team wanted to model a 5% DRG increase, add a high-cost drug carve out, or change a stop-loss threshold. In short, Managed Care teams now have the power of a dedicated analytics team whenever they need, turning a multi-month wait time into a 5 minute self service tool.
Dedicated Renegotiation Tracker & Prioritization Tool
While most teams are forced to manually keep track of contract deadlines and expirations, AI offers a rescue for this time consuming and redundant task. An automated renegotiation tracker that can be filtered by rate age, volume and hard deadlines ensures that teams don’t miss important opportunities for negotiating rate increases. It also offers insights into the real dollar value of your current rates, in the context of your claims, and helps teams prioritize the most important, weakest performing, and time sensitive contracts for negotiation. With Kubera’s deadline and renegotiation AI tool, teams are able to get prompt rate increases and ensure they don’t stay locked into stale terms or less competitive fee schedules.
Contexted Benchmarking Data
Many managed care and rev cycle teams don’t utilize benchmarking data because of the difficulty to make sense of all the transparency data in the context of their own rates. However, inside an AI powered platform extracted rates can be quickly and easily benchmarked to the most relevant comparisons. This allows teams to benchmark their rates against different industry peers, in addition to comparing rates internally (across your own payors and locations).
Automated Price Transparency and MRF Reporting
Many hospitals and health systems undergo an annual fire drill of manually assembled MRF reporting once a year which can take months of valuable time away from other areas. The burden can even compound when MRF requirements change throughout the year requiring more frequent reports. However, Kubera’s AI platform gives teams that time back by creating MRF reports in minutes.
Continuous and Automatic Payor Policy Monitoring
Managed care and rev cycle teams are oftentimes manually tracking for payor policy updates. Instead of the weekly slog through Availity, newsletters, and individual payor websites Kubera offers active Policy Payor monitoring. Again, our AI layer allows this information to be summarized, searchable by payor, geography, code, and effective date while automatically being tied to the sections of your active contracts it affects. In practice, this looks like catching a policy change that shouldn’t have applied and then contesting a material change before it causes any damage. As well as, automatic notification of actionable rules within policies which acts as an active denial prevention barrier.
Interconnected Payment Variance Queue
While revenue cycle teams often have some insight in their payment variances, the process of diagnosing the root cause and prioritizing the most recoverable variances takes a large administrative burden. Kubera ties the same structured terms directly to a health system’s variances which allows teams to filter them down to any payor, location, or code while also being tied to the exact contract language. So on top of an accurate expected vs. collected dashboard, teams get automatic variance underpayment bucketing for the prevention of major leakages.
An Embedded AI Layer
Where the majority of the managed care and rev cycle world is lagging behind lies in its integration with AI. While all the features mentioned above utilize AI in some form to maximize efficiency and effectiveness Kubera ties an interactive AI layer on top of that. Our agentic AI, Kai, can be utilized to ask questions in plain english and surface answers in fractions of what it previously took teams. This is the element that ties together the solution to many organization's biggest problems and offers managed care and rev cycle teams a new advantage in their everyday workflows.
What this Adds Up To
Individually, each of these changes saves a team hours. Together, they change what a Managed Care or Rev Cycle department is actually capable of. When properly utilized teams actually have room to get ahead of problems instead being buried in manual reporting and reactive variance