User Guide

Getting Started with DRG-AI

Step-by-step guides for the AR-DRG v9.0 Edge-Powered Compliance Engine. From case input to NPHIES claim generation.

Role-Based Dashboard Views

Coder

Case Input + Grouping Result

RCM Director

Analytics + Shadow Billing

Auditor

Audit Log + Conformance

Finance

Pricing + Payer Config

Quick Start

Configure Payer Tariffs

Set up payer-specific rates, emergency surcharges, and ICU per diem.

Cmd+Shift+P

Browse DRG Codes

Explore all 909 AR-DRG v9.0 codes organized by MDC.

Cmd+Shift+D

AI Assistant

Get coding suggestions, cost optimization tips, and compliance checks.

Cmd+K

Keyboard Shortcuts

All keyboard shortcuts for power users.

Cmd+/

Pre-Submission AR-DRG Simulation

Revenue Capture & DRG Optimization

1

Enter the Case

Input principal diagnosis, additional diagnoses, procedures, and demographics.

  • Search ICD-10-AM codes by code or description
  • Add SBS procedures with OR indicators
  • Set age, gender, LOS, ICU days, admission type
  • Select payer (MOH, CCHI, Tawuniya, Bupa, Self-Pay)
2

Run Deterministic Grouping

Execute the 12-step AR-DRG v9.0 algorithm on the managed Edge node.

  • All processing stays within the KSA region (PDPL compliant)
  • SHA-256 hashed input for audit reproducibility
  • Redis cache for repeated identical cases
  • Results in <100ms for cached, <2s for new cases
3

Review AI Suggestions

Review AI-identified missing diagnoses that could upgrade the DRG weight.

  • Confidence score for each suggestion
  • Revenue impact calculation (weight gain, SAR increase)
  • HITL enforcement: must accept/reject before NPHIES
  • 24-hour expiration on pending suggestions
4

Accept & Re-Group

Accept AI suggestions to automatically re-run the grouping with updated codes.

  • One-click accept/reject per suggestion
  • Automatic re-grouping with new diagnosis included
  • Full audit trail of accepted/rejected codes
  • Escalation path to senior coder for uncertain cases

Real-Time Coding Autocomplete

Natural Language Code Search

1

Open Code Search

Click into any diagnosis or procedure field in the Case Input Panel.

  • Supports natural language queries
  • Also accepts direct ICD-10-AM or SBS codes
  • Real-time results as you type
2

Type Your Query

Type a description like "CT chest with contrast" and see matching codes.

  • Prefix match on code (e.g., "SR030")
  • Substring match on short and long descriptions
  • Results sorted by code match priority
  • Up to 20 results per query
3

Select & Auto-Fill

Click the desired code to auto-fill procedure details.

  • Auto-populates OR status, complexity, and MOH price
  • Constrained to valid Saudi SBS/ICD-10-AM codes only
  • Invalid codes from AI are filtered (hallucination prevention)

NPHIES Claim Generation

FHIR R4 e-Claim Export

1

Verify NPHIES Readiness

Navigate to Compliance → NPHIES Readiness to check 28 field mappings.

  • Readiness score blends mapping completeness (60%) + data availability (40%)
  • 10 conditional rules (e.g., birthWeight for neonatal)
  • Per-case readiness assessment with field-level validation
2

Export FHIR Bundle

Generate a validated FHIR R4 Bundle with Patient, Encounter, Conditions, Procedures, and Claim.

  • Zod-validated resources (Patient, Condition, Procedure, Claim)
  • SBS-to-SNOMED mapping for procedure codes
  • AR-DRG v9 format validation (###A/B/C/Z/D)
  • NPHIES-specific transforms (gender, facility tier, admission type)
3

Submit to Payer

Export the validated bundle for manual or API-based NPHIES submission.

  • HMAC-signed audit entry for every export
  • PHI egress logged in PDPL audit trail
  • Export formats: JSON, CSV
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