India’s healthcare insurance penetration has increased significantly over the past decade and is expected to keep growing as more households gain formal coverage. Much of this expansion has been driven by Ayushman Bharat, a government-funded health insurance scheme for low-income families in India, which now covers more than 500 million people, and by the Employees’ State Insurance Scheme, which supports over 150 million workers. As coverage has expanded, small and mid-sized hospitals are treating a growing number of insured patients while managing longer receivable cycles and complex claims processes, putting added stress on healthcare providers. CareFi addresses this challenge by providing working capital financing alongside AI-enabled revenue management tools that help hospitals manage cash flows and claims at scale. Accion Ventures is proud to invest in CareFi as they seek to build the infrastructure for a more resilient, tech-enabled healthcare ecosystem in India.

A critical gap in healthcare financing

As insurance coverage has expanded for low-income and underserved populations, much of the resulting demand has been absorbed by a growing base of private hospitals, particularly in smaller towns across India. Between 2019 and 2024, the number of private hospitals increased by 27 percent, from about 30,000 to 38,000. Most of these facilities have fewer than 100 beds, yet they now represent 46 percent of empanelled facilities under government insurance schemes and account for 54 percent of total hospitalizations. While this shift has meaningfully improved access and, in many cases, quality of care, it has also placed new pressure on provider cash flows. Hospitals must navigate multiple payer rules, varied documentation standards, and fragmented claims processes. Delays, partial payments, and rework are common, making collections unpredictable and stretching working capital.

Enabling financial inclusion for providers and patients

CareFi seeks to address the gap with a bundled model designed for hospitals. It provides working capital financing through its NBFC against expected insurance receivables, supported by healthcare‑specific underwriting developed by a dedicated team of underwriters and clinicians. This matters because insurance receivables are inherently complex: schemes and insurers follow different rules, documentation standards vary, and adjudication can differ by program and region. Traditional lenders are not equipped to consistently assess these nuances, leaving many hospitals without timely credit precisely when claim volumes rise.

Alongside financing, CareFi offers an AI‑driven revenue management layer that streamlines core claim workflows and improves visibility across submissions and reconciliations, making cash inflows more predictable for hospitals. The platform also supports a simplified discharge flow that allows hospitals to settle small out-of-pocket balances, enabling patients to leave without delay. Fees are charged transparently to hospitals, with no cost passed on to patients.

Together, this combination of specialized credit for receivables and intelligent workflow support allows hospitals to continue serving insured patients without requiring upfront payments or delaying discharge. The result is fewer interruptions to care, a more reliable cashless experience, and stronger protection for families who might otherwise turn to costly borrowing or defer treatment.

Leveraging AI to organize and standardize hospital data

CareFi’s technology applies AI to convert large volumes of unstructured information into consistent, reviewable claims. A single patient file can span hundreds of pages, including clinical notes, diagnostics, invoices, and scheme-specific forms. Historically, this lack of standardization made it difficult to validate documentation, apply payer rules consistently, or predict claim outcomes. CareFi’s AI-based system parses and structures these documents, checks completeness, maps payer and scheme requirements, flags likely delays or deductions, and accelerates reconciliation by matching remittances to claims and identifying the root causes of shortfalls. In effect, the technology standardizes what was previously unstandardized, bringing order and predictability to workflows that are impractical to manage at scale with manual processes alone.

Importantly, these capabilities are deployed with guardrails that prioritize accuracy. Human reviewers remain responsible for edits and final submissions, and each recommendation carries a plain-language reason code tied to the relevant rule or data signal. Payer and scheme policies act as hard constraints that the models cannot override. Models are limited to the data required for each task, with sensitive fields protected through strict access controls and de-identification where appropriate. The result is automation that reduces avoidable errors and shortens days sales outstanding, while preserving transparency, auditability, and data security.

Looking ahead

CareFi supports inclusion for low-income individuals who have recently gained insurance coverage and the smaller providers in smaller towns that deliver quality care across India. The company underwrites hospital insurance receivables to provide timely working capital and offers AI-driven tools and analytics that make insurance revenue more predictable and easier to manage. By strengthening provider cash flows and simplifying the path from claim to collection, CareFi helps sustain cashless care at scale and strengthens healthcare delivery for the communities that rely on it most. We’re proud to invest in CareFi as it continues to build infrastructure to make cashless care work for hospitals and patients.