Which DRG system does Saudi Arabia use?

AR-DRG, the Australian Refined system maintained by IHACPA. It was introduced by the Council of Health Insurance as a payment mechanism, and claims are exchanged through NPHIES alongside the Saudi Billing System.

The National Platform for Health and Insurance Exchange Services: the Saudi national exchange through which eligibility checks, pre-authorisations and claims move between providers and payers. A DRG claim in the Kingdom reaches the payer through it.

What is the Saudi Billing System?

The Kingdom’s national billing code set, used alongside the clinical classifications. The coded record is mapped to SBS before the claim is submitted, which is why validation against it before submission matters more than it might sound.

Is NANO’s grouper certified?

NANO DRG is an AR-DRG grouper certified by IHACPA through AR-DRG V12.0, and the certificate is available on request. Certification of grouper software has existed only since V10.0, so a claim about any earlier version would be a claim about something that does not exist.

Do we need to re-code if we already work in ICD-10-CM?

In part, yes. AR-DRG is fed by ICD-10-AM and ACHI, which is a different convention from ICD-10-CM with CPT rather than simply a different list. A crosswalk covers a lot of ground, and NANO DRG supports ICD-10-CM, ICD-10-AM and ICD-9-CM with a crosswalk to ICD-10-AM — but plan for coder capability in the target standard.

How do we know what the change is worth before we make it?

Shadow billing. Run DRG grouping and pricing alongside your existing billing and compare: you see your real casemix and what it would pay while you can still act on the gap. Finding out after the payment rules change is the expensive order.

Does AR-DRG cover outpatient care?

AR-DRG is an admitted-acute classification, and in the Kingdom it is applied to admitted and daycare encounters. It is not an ambulatory classification in the way IR-DRG is, which is one of the structural differences between the Saudi and UAE models.

AR-DRG in Saudi Arabia: what CHI requires

Saudi Arabia classifies admitted care on AR-DRG — Australian Refined Diagnosis Related Groups, maintained by IHACPA. The Council of Health Insurance introduced it as a payment mechanism, claims are exchanged through NPHIES alongside the Saudi Billing System, and providers in the Kingdom group on AR-DRG Version 9.0.

By NANO Health Suite Clinical & Coding Team · Last updated 2026-09-20

What CHI introduced, and why

The Council of Health Insurance brought AR-DRG in as a billing and payment mechanism, initially in the context of public providers treating beneficiaries of mandatory private health insurance. The direction of travel is the one the Kingdom has stated repeatedly: away from paying for activity and towards paying for episodes of care, as part of a broader move to value-based healthcare.

The practical effect is the same as anywhere DRG funding lands. What a hospital is paid stops depending on the length of the bill and starts depending on the class the episode falls into — and that class comes entirely from the coded record.

Value-based healthcare

Which version is in force

Providers in Saudi Arabia currently group admitted and daycare encounters on AR-DRG Version 9.0, with the Saudi Billing System alongside it.

That is not the newest AR-DRG version internationally, and the two facts should be kept in separate sentences because they answer different questions. IHACPA approved Version 12.0 in April 2025, and it prices admitted acute care episodes from 1 July 2026, underpinned by ICD-10-AM, ACHI and ACS Thirteenth Edition. What a Saudi provider is measured against today is V9.0; what exists internationally is further ahead.

Certification is a different question from version support

IHACPA certifies grouper software, and has done so only since AR-DRG V10.0. Certification means the grouper has been independently tested to reproduce the classification correctly — the difference between a number you can put in front of a regulator and one you can only assert.

So the two claims are separate. NANO DRG is an AR-DRG grouper certified by IHACPA through AR-DRG V12.0. NANO AR-DRG for Saudi Arabia is the Kingdom-specific edition, grouping on the Version 9.0 in force locally with Saudi Billing System mapping and validation before submission to NPHIES. Separately again, NANO Health Suite is an accredited licensee of IHACPA for the AR-DRG classification, which is a licence to develop and distribute rather than a statement about any particular version.

The IHACPA certificate is available on request — ask through the contact form and it can go to your procurement or audit team.

Coding: ICD-10-AM, ACHI and ACS

AR-DRG consumes the Australian coding standards, and this is the part that surprises groups arriving from the UAE. Diagnoses are coded in ICD-10-AM, procedures in ACHI, and the coding rules themselves are ACS. That is a different convention from ICD-10-CM with CPT, not merely a different code list, so coder capability has to be built rather than mapped.

On top of that sits the Saudi Billing System, which the coded record is mapped to before the claim reaches NPHIES. Validation before submission is worth more here than anywhere: a claim rejected at the exchange is a claim you get back to rework, and the rework is the expensive part.

What a Saudi provider needs in place

Coders working in ICD-10-AM and ACHI to ACS standards — the classification is only as good as the coding underneath it.
Documentation that records the comorbidities actually treated, because complexity that is not written down is complexity that is not paid.
A grouper on the version the Kingdom is measuring against, with a clear path to the next one.
Saudi Billing System mapping and code validation BEFORE the claim reaches NPHIES.
Shadow billing against current revenue, so the size of the change is known before it arrives rather than after.

If you also operate in the UAE

Then you are required to satisfy two classifications at once: AR-DRG from ICD-10-AM and ACHI in the Kingdom, IR-DRG from ICD-10-CM and CPT in the Emirates. NANO DRG is certified by IHACPA through AR-DRG V12.0 and supports ICD-10-CM, ICD-10-AM and ICD-9-CM with a crosswalk to ICD-10-AM. NANO AIR-DRG produces IR-DRG output. Running both on one platform is what makes a group-level view of casemix possible at all.

Frequently asked questions

Which DRG system does Saudi Arabia use?: AR-DRG, the Australian Refined system maintained by IHACPA. It was introduced by the Council of Health Insurance as a payment mechanism, and claims are exchanged through NPHIES alongside the Saudi Billing System.
Which AR-DRG version is in force in the Kingdom?: Version 9.0, for admitted and daycare encounters, used with the Saudi Billing System. Internationally, IHACPA approved Version 12.0 in April 2025 and it prices admitted acute care from 1 July 2026 — a separate fact about the classification, not about what a Saudi provider is measured against today.
What is NPHIES?: The National Platform for Health and Insurance Exchange Services: the Saudi national exchange through which eligibility checks, pre-authorisations and claims move between providers and payers. A DRG claim in the Kingdom reaches the payer through it.
What is the Saudi Billing System?: The Kingdom’s national billing code set, used alongside the clinical classifications. The coded record is mapped to SBS before the claim is submitted, which is why validation against it before submission matters more than it might sound.
Is NANO’s grouper certified?: NANO DRG is an AR-DRG grouper certified by IHACPA through AR-DRG V12.0, and the certificate is available on request. Certification of grouper software has existed only since V10.0, so a claim about any earlier version would be a claim about something that does not exist.
Do we need to re-code if we already work in ICD-10-CM?: In part, yes. AR-DRG is fed by ICD-10-AM and ACHI, which is a different convention from ICD-10-CM with CPT rather than simply a different list. A crosswalk covers a lot of ground, and NANO DRG supports ICD-10-CM, ICD-10-AM and ICD-9-CM with a crosswalk to ICD-10-AM — but plan for coder capability in the target standard.
How do we know what the change is worth before we make it?: Shadow billing. Run DRG grouping and pricing alongside your existing billing and compare: you see your real casemix and what it would pay while you can still act on the gap. Finding out after the payment rules change is the expensive order.
Does AR-DRG cover outpatient care?: AR-DRG is an admitted-acute classification, and in the Kingdom it is applied to admitted and daycare encounters. It is not an ambulatory classification in the way IR-DRG is, which is one of the structural differences between the Saudi and UAE models.

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