DRGAI

Saudi Arabia · CHI · Saudi AR-DRG v9.0

Saudi CHI-aligned AR-DRG platform — NPHIES-ready claims intelligence, SBS V3 cost logic, PDPL residency.

AI absorbs the chart, proposes codes with evidence, and drafts CDI — deterministic Saudi AR-DRG v9.0 rules assign the group. NPHIES mapping/readiness, CHI-aligned compliance reporting, and SAR-denominated SBS V3 cost breakdowns.

DRG · assign

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RW 2.245

K35.8

Principal locked

RW

2.245

live topology · instrument demo

AI absorb pathway

Chart fields stream into the grouper hub

Saudi AR-DRG · live engine

Deterministic assignment path · AI assist on absorb

live links

3

847

Passing tests

Vitest suite · regional isolation + claims

Saudi CHI alignment

Built against the standards Saudi Arabia actually enforces.

Every card below is backed by code in this repository — grouping steps, codesets, controls, and integration scaffolding you can audit before signing a contract.

Mapping only

NPHIES Mapping & Readiness

NPHIES is mapping/readiness only — direct submission is not implemented. Claims framing and MDS alignment are prepared for the external submission path.

Mapping / readiness · No direct submission · CHI-aligned reporting

Live

Saudi AR-DRG v9.0 Grouper

Native Saudi AR-DRG v9.0 grouping and medical coding — live deterministic engine with CHI-aligned rules. 8-step deterministic algorithm with DCL/ECCS severity and SBS procedure hierarchy.

Live engine · CHI-aligned rules · 8-step algorithm · DCL / ECCS

Loaded

ICD-10-AM + ACHI Codesets

Real imported codesets — not seeded fixtures. Diagnosis and procedure lookups return catalogue rows that match payer expectations.

ICD-10-AM · ACHI · RefCodingEntry-backed regional search

Live

SBS V3 Cost Logic

SAR-denominated cost breakdowns per DRG with payer-specific tariffs from the Saudi Billing Schedule (SBS V3). Case-level economics from base weight to net cost.

SAR · SBS V3 tariffs · Payer-specific · Base-to-net breakdown

Aligned

Saudi PDPL Residency

Saudi PDPL — in-Kingdom data residency. Data protection aligned with the Kingdom’s Personal Data Protection Law framework for health data processing.

In-Kingdom residency · PDPL-aligned · Health-data safeguards

Aligned

CHI Compliance Reporting

Compliance reporting aligned with Saudi MOH / CHI requirements. Official CHI certification remains external — reports are conformance artifacts, not certifications.

CHI-aligned · Conformance artifacts · Certification external

Other markets run as demo-complete deployments — not the Saudi build.

The cascade

Trace the grouper path.Eight stages. One DRG.

Absorb → candidates → CDI → MDS → deterministic group → human confirm. AI enriches; rules assign.

01/08

grouping console

AI

Saudi AR-DRG · live engine

01 · Chart absorb

Note becomes structure.

AI reads the chart into principal, secondaries, and procedures — without rewriting the medical record.

chart stream · AI absorb

  • 62M · chest pain 6h · diaphoretic
  • Troponin I elevated · ST elevation V2–V4
  • Known T2DM · metformin · HbA1c 8.2
  • Cath: PCI LAD single stent · LOS day 5

Principal hint

Acute MI — anterior

AI

CC signal

Type 2 DM documented

AI

Procedure

PCI extracted from cath

AI

LOS / discharge

5d · home

MDS

Deterministic core · AI assist

Optimize or audit.One case. Two modes.

Flip documentation and comorbidity. AI refreshes findings; deterministic Saudi AR-DRG rules reassign the DRG — explainable trail, never a revenue promise.

Saudi AR-DRG · case bench

Chest pain · elevated troponin · PCI considered

  • I21.0
  • 44950

AI candidates · disposition

assist · not autolock

  • I21.0

    ST elevation V2–V4

  • E11.9

    HbA1c · metformin

Severity path

C · MINC

AI-assisted assignment

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● LICENSED PATH

relative weight

2.189

AI enrichmentDeterministic coreDoc gaps open

AI findings to act on

  • AIAI flags thin principal specificity in the note — tighten before lock.
  • CCComorbidity capture open vs Saudi AR-DRG severity ladder.

Illustrative DRG assignment panel. Production engines stay on the grouper — this panel shows AI assist + deterministic controls.

Integration Hub

Plugs into the systems you already run.

Native FHIR R4 and HL7 v2 messaging, plus first-class adapters for every major claims platform in the region. Register an endpoint, push data, watch it land — fully audited.

Your regionSaudi Arabia· NPHIES
🇸🇦 NPHIES🇦🇪 eClaimLink🇦🇪 Shafafiya🇶🇦 NHIC e-Claims (Seha)🇴🇲 Dhamani🇧🇭 Sehati / I-SEHA🇰🇼 Per-payer (Afya / Dhaman)🇸🇬 MediClaim / MOH Casemix🇲🇾 MOH Casemix System🇹🇭 NHSO e-Claim🇬🇧 NHS Payment Scheme (API)🇺🇸 X12 837 / UB-04🇦🇺 Activity-Based Funding (NWAU)🇨🇦 Provincial Claims Systems🇪🇺 National e-Claims🌍 Configurable Integration

FHIR R4 — Any resource, any system

  • Generic resource store — Patient, Encounter, Observation, Claim, Coverage…
  • Bundles accepted: every entry stored and indexed individually
  • Upsert by (resourceType, id) — safe re-sends, no duplicates
  • PDPL-safe patient linking via tokenized subject references
POST /api/integrations/fhir
{
  "resourceType": "Patient",
  "id": "pt-1001",
  "identifier": [{ "value": "MRN-1001" }],
  "name": [{ "family": "Al-Rashid", "given": ["Sara"] }]
}

Workspace analytics

Casemix, shadow, quality, AI— as your team runs them.

Workspace views your team runs: casemix mix, billed vs grouper, coding gaps, and AI/CDI assist. Seeded walkthrough figures — not live claims.

MDC · complexity · CMI

Casemix instrument · Saudi AR-DRG walkthrough

◇ ILLUSTRATIVE SEED

Case mix index

1.842

Grouping runs

1284

MDCs active

8

Top-5 cost share

52.4%

MDC distribution

volume

MDC 05
214
MDC 04
168
MDC 06
142
MDC 08
121
MDC 01
98
MDC 11
87
MDC 10
76
MDC 07
64

Complexity distribution

DCL ladder

MAJC (A)18%
INTC (B)34%
MINC (C)27%
WithoutCC (Z)21%

Top DRGs by volume

avg illus.

F07A
86
E65B
72
G12A
61
I08B
54
J12A
48
B70B
41

Volume by specialty

Cardiology
196
Internal med
174
Orthopedics
132
General surg
118
Neurology
91

Volume by payer

MOH
412
Bupa
268
Tawuniya
221
Medgulf
154
Other
98

Authority ledger

AI proposes.
Authority stays human.

Pick a documentation scenario. Watch the AI channel move — then the human gate close. Trust on the instrument, not in a brochure.

Live probe · format

format · not clinical validity

Well-formed ICD-10-AM

Clinical formatSaudi AR-DRG formatRefuse match

Authority needle

AI ← → Human

AI channel hot — human gate still required

Scenario instrument

● LIVE

AI channel

  • Flags unspecified AMI — presses for site specificity
  • Drafts a CDI query to cardiology
  • Keeps the severity path open until the reply lands

Human owns

  • Accepts or kills the specificity ask
  • Physician answers on the medical record
  • Principal diagnosis remains a human call

Deterministic DRG at the core · AI enriches · hard stop at human authority

Expandable ledger

DRGAI

Bring a live chart. Leave ready to defend the DRG.

AI maps the note into structured fields — the chart never leaves your control.

ai assist · deterministic rules · human authority