NANO DRG
Grouping, costing and shadow billing for DRG-funded care
At a glance
A DRG — Diagnosis Related Group — classifies a hospital stay into one payment class from its coded diagnoses and procedures, so a hospital is paid for the episode rather than for each line item. NANO DRG is an AR-DRG grouper certified by IHACPA through AR-DRG V12.0.
- What it is
- A DRG grouper — it turns a coded episode into its payment class
- Classification
- AR-DRG, certified by IHACPA through AR-DRG V12.0
- Code sets
- ICD-10-AM with ACHI and ACS; also ICD-10-CM and ICD-9-CM, with a crosswalk to ICD-10-AM
- Grouping
- Deterministic — the same coded episode always produces the same group
- Before you switch
- Shadow billing runs DRG pricing beside your current billing
- Where it is used
- Saudi Arabia (AR-DRG via CHI, submitted through NPHIES) and DRG-funded systems generally
When funding moves to DRG, revenue follows the coded record
An IHACPA-certified AR-DRG grouper, in both of the coding worlds the Gulf actually runs
DRG changes what a hospital is paid for. Not the number of line items on a bill, but the class the episode lands in — and that class is only ever as good as the record behind it. The same operation, documented two ways, is two different payments.
Certified, not just claimed. NANO holds IHACPA certification for its AR-DRG grouper through AR-DRG V12.0 — the version approved to price admitted acute care episodes from 1 July 2026, underpinned by ICD-10-AM/ACHI/ACS Thirteenth Edition. IHACPA has certified grouper software since V10.0, and certification means the grouper has been independently tested to reproduce the classification correctly. It is the difference between a grouper you can put in front of a regulator and one you cannot.
Both coding worlds, and the crosswalk between them. Saudi Arabia codes in ICD-10-AM with ACHI procedures and groups on AR-DRG; the UAE runs ICD-10-CM and CPT. A group operating in both is running two standards at once. NANO DRG supports ICD-10-CM, ICD-10-AM and ICD-9-CM with ACHI, and crosswalks to ICD-10-AM — one system that speaks both.
Shadow billing, before the money changes. Run DRG grouping and pricing alongside your existing billing and see your real case-mix, and what it is worth, while you can still act on it. Finding out after the payment rules switch is the expensive way to learn.
Deterministic grouping. Given the coded episode, the grouper applies the classification logic exactly, every time — which is what certification tests. What varies is the documentation feeding it, and that is why grouping, coding and documentation integrity belong on one platform rather than three.
Integration & Deriving Medical Data
DRG Grouping Algorithms
Return on investment
The same patient, documented two ways
A 52-year-old woman is admitted for a thyroidectomy, principal diagnosis nontoxic multinodular goitre. Recorded as that alone, the episode groups to K06B — Thyroid Interventions, Minor Complexity, at a cost weight of 1.84.
Document the comorbidities that were actually treated — asthma, type 2 diabetes, anaemia — and the identical episode groups to K06A, Major Complexity, at a cost weight of 3.57. Same patient, same operation, nearly double the weight. That gap is what clinical documentation integrity is worth on a single admission, and it is why NANO DRG is built to sit beside NANO AI CDI 360.
What you get
IHACPA-certified AR-DRG grouper, through AR-DRG V12.0
Shadow billing — model DRG revenue against your current billing before the switch
An intelligent batch bundle grouper, for episode volumes a person cannot review one by one
Case-mix centralised costing, so what an episode costs and what it classifies as sit in one place
Case-mix centralised costing, plus reporting, notification and customised report engines
Scrubber Coding Rules Engine
The coding rules engine runs production rules against inpatient state transitions before an episode is grouped, so contradictions, age and gender mismatches and sequencing problems surface while the record can still be corrected — not in a rejection letter weeks later.
Certified, and built for a region mid-transition
Gulf funding models are moving to classification-based payment on their own timelines, and most groups will run old and new side by side for a while. NANO DRG is designed for that overlap: an IHACPA-certified grouper through V12.0, support for the classification versions still in regional use, multiple code sets at once, shadow billing against live operations, and integration into the systems already in place rather than a replacement programme.
Need a Quick Call?
Let's Talk About Business Solutions with Our Team
Related products
Products in the suite that work alongside this one.
More about this product
Standards and code sets
- AR-DRG
- ICD-10-AM
- ACHI
- ACS
- ICD-10-CM
- ICD-9-CM
- NPHIES
How this works with the rest of the suite
- NANO AIR-DRG
NANO AIR-DRG groups an episode before coding is complete; NANO DRG produces the classification that has to stand up to a regulator. Most groups need both.
- NANO AI CDI 360
The group is only ever as good as the record behind it — CDI 360 is what makes the documentation complete before the episode is grouped.
- NANO AR-DRG KSA
The Kingdom-specific edition: AR-DRG Version 9.0, the version in force in Saudi Arabia, with Saudi Billing System mapping and NPHIES validation.
- NANO PLICS
Grouping tells you what an episode is classified as; patient-level costing tells you what it actually cost you to deliver.
- NANO CDSS
Grouping decides the class; clinical decision support shows where your pricing sits against what payers actually approve.
Frequently asked questions
What is a DRG system?
- A DRG (Diagnosis Related Group) system sorts hospital stays into classes that are expected to use similar resources, and pays one amount for the class rather than for each service delivered. The class is worked out from the principal diagnosis, any additional diagnoses, the procedures performed, and patient factors such as age and discharge status. It moves the financial question from "how many items were billed" to "what kind of episode was this, and how well is it documented".
What does a DRG grouper actually do?
- A grouper is the software that applies the classification rules. It takes the coded episode — diagnoses, procedures, demographics, discharge status — and returns the single group that episode belongs to, along with its cost weight. It is deterministic: the same coded episode produces the same group every time. What varies between two hospitals is not the grouper, it is the quality of the record being fed into it.
Is NANO DRG certified?
- Yes. NANO holds IHACPA certification for its AR-DRG grouper through AR-DRG V12.0. Certification means the grouper has been independently tested to reproduce the classification correctly, which is what lets you put it in front of a regulator. IHACPA has certified grouper software only since V10.0, and NANO’s certification runs through AR-DRG V12.0. The certificate is available on request.
Which DRG system does Saudi Arabia use?
- Saudi Arabia uses AR-DRG, the Australian Refined system maintained by IHACPA, introduced by the Council of Health Insurance as a payment mechanism and exchanged through NPHIES. Providers code in ICD-10-AM with ACHI procedures. NANO AR-DRG for Saudi Arabia is the Kingdom-specific edition, grouping on AR-DRG Version 9.0 with Saudi Billing System mapping.
Which DRG system does the UAE use?
- The UAE uses IR-DRG, the International Refined family. Abu Dhabi’s Department of Health made it the accepted inpatient claiming method from 1 January 2013, and Dubai’s DHA mandated DRG submission on eClaimLink from 1 September 2020, choosing IR-DRG because it fits Dubai’s existing ICD-10-CM and CPT coding. NANO AIR-DRG produces IR-DRG output for that submission.
We operate in both Saudi Arabia and the UAE. Do we need two systems?
- You need to satisfy two different classifications, which is a real constraint rather than a preference: Saudi Arabia groups on AR-DRG from ICD-10-AM and ACHI, and the UAE groups on IR-DRG from ICD-10-CM and CPT. NANO DRG is the IHACPA-certified AR-DRG grouper and supports ICD-10-CM, ICD-10-AM and ICD-9-CM with a crosswalk to ICD-10-AM, and it is certified by IHACPA through AR-DRG V12.0. NANO AIR-DRG produces IR-DRG output. Both run on one platform, which is the point.
What is casemix, and how does it relate to DRG?
- Casemix is the mix of episode types a hospital actually treats, expressed through the DRG classes those episodes fall into and the cost weight of each. It is what turns a list of admissions into a fundable picture of the work done. Two hospitals with identical admission numbers and very different casemix are doing very different work and should not be paid the same.
How much difference does documentation make to the payment?
- Enough that it is usually the largest single variable. On this page there is a worked example: a thyroidectomy recorded with the principal diagnosis alone groups to K06B at a cost weight of 1.84, while the same admission with the comorbidities that were actually treated groups to K06A at 3.57. Same patient, same operation, nearly double the weight. The figures are illustrative of the classification, not a promise about your case mix.
Can we see what DRG would pay before we switch to it?
- Yes, and it is the part worth doing first. Shadow billing runs DRG grouping and pricing alongside your existing billing, so you see your real casemix and what it is worth while you can still act on it. Discovering the gap after the payment rules change is the expensive way to learn it.
Does the grouper need our whole record to be coded first?
- NANO DRG does — it is the deterministic, certified grouper and it applies the classification to a coded episode. Where coding capacity is the constraint, NANO AIR-DRG groups without waiting: it carries its own procedural code set and treats ICD coding as an optional input. The usual pattern is to see the episode early with AIR-DRG and confirm it with the certified grouper.
Related questions
- What does the wider health-IT platform cover?
- How are claims exchanged with payers?
- Can the coding rules be maintained by our own team?
- How do we audit what was billed afterwards?
- What is a DRG system?
- How do MS-DRG, IR-DRG and AR-DRG differ?
- What is casemix funding?
- What does Saudi Arabia require?
- See every product in the suite
IHACPA certificate available on request
We can send the certificate to your procurement or audit team. Ask for it through the contact form.
Request the certificate