Pay the right class
C26 Cardiology billed where the evidence supports C03 General medicine costs AED +251.64 more per service event.
Overpayment risk by rule
For insurers, TPAs and government payers
Audit every ADOC claim before you pay it — and price your network before you sign it.
Portal access, integration and your first shadow run — within 24 hours of receiving access to your claims files and systems.
ADOC, the Abu Dhabi Outpatient Classification, is the Department of Health – Abu Dhabi’s casemix classification that pays each outpatient service event by its class. It becomes Abu Dhabi’s primary outpatient reimbursement mechanism on 1 January 2027. NANO ADOC & E&M Audit 360 lets insurers and TPAs check every ADOC claim before they pay it.
NANO ADOC & E&M Audit 360 re-groups each outpatient claim from its supporting lines, the clinician’s specialty and the diagnosis, replays the counting rules across days, clinicians and facilities, checks every adjuster, and audits E&M levels wherever fee-for-service continues. Every finding names the rule it rests on.
- ADOC claim audit on the v1.5 rules, including the counting rules and the M-Series
- Re-grouping with the NANO ADOC grouper
- Network tariff and series-multiplier modelling
- E&M audit where fee-for-service continues
Finding — a class above the evidence
AED +251.64
Billed C26 Cardiology at AED 492.67; the evidence supports C03 General medicine at AED 241.03 — a variance of AED +251.64 per service event, before the provider’s series multiplier.
Rule: ADOC Definitions Manual, class selection by the leading clinician’s specialty.
Draft v1.5 prices for shadow billing only — not for calculating payments.
Per service event, before your series multiplier. Source: Department of Health – Abu Dhabi, ADOC v1.5 Price List · DoH draft v1.5
Business value for insurers and TPAs
What Audit 360 is worth to your claims operation
ADOC pays one price per service event, so a wrong class, a missed follow-up rule or a misapplied adjuster overpays a whole event. These are the places it happens — each priced per service event from the DoH draft v1.5 Price List, before the provider’s series multiplier.
Stop follow-up leakage
A same-class follow-up within 7 days is zero value, and on day 8–14 most consultation classes pay ×0.75. Without an evidenced exemption, a C38 follow-up on day 8–14 is AED 113.34, not AED 151.12.
Follow-ups billed above the rule
Stop adjuster misuse
New-patient status is checked against three years of your own claims. A new-patient flag wrongly applied to C26 adds AED +197.07; a Centre of Excellence adjuster on C19 without an eligible diagnosis adds AED +59.26.
Adjusters failing their eligibility test
No double-paid diagnostics
D-Series diagnostics sit at zero inside the visit, one M-Series claim is allowed per ordering consultation, and send-out tests are claimed only by the ordering facility. An extra cancer-pathology repeat line is AED 187.04.
Priced diagnostic lines outside the rules
Price the network on evidence
One multiplier per series, per provider branch and product — modelled on your own claims before contracts close.
Network cost against fee-for-service, by series and provider
Predictable outpatient spend
One price per service event instead of one per line, so cost per event can be followed by series, class and provider.
Cost per event over time
Fewer disputes, faster adjudication
Every finding cites the ADOC rule and the document page it rests on, so a provider can see why and a reviewer can confirm it.
Findings accepted and disputed
Target your audit effort
Providers are profiled by class mix, follow-up rate and adjuster use, so audit time goes to the outliers.
Providers outside peer norms
E&M audit where fee-for-service continues
Primary care and emergency visits stay outside ADOC and keep billing E&M levels; each level is scored against the note.
E&M levels against the documentation
What your audit report measures
- Overpayment risk by rule
- Providers outside peer norms
- Network cost against fee-for-service, by series
- Follow-up and adjuster findings by provider
- Findings accepted and disputed
Amounts are DoH ADOC v1.5 draft prices per service event, before the provider’s series multiplier, published for shadow billing.
Draft v1.5 prices for shadow billing only — not for calculating payments.
Per service event, before your series multiplier. Source: Department of Health – Abu Dhabi, ADOC v1.5 Price List · DoH draft v1.5
Six ways an ADOC claim goes wrong
Each check rebuilds the claim the way the DoH documents describe it, then compares it with what was billed.
A class above the evidence
The highest-priced class wins within a series. The class is re-derived from the supporting procedure lines, the leading clinician’s specialty and the principal diagnosis.
One visit split in two
One event per series, per patient, per clinician, per day; a deferred inclusion procedure is a continuation at zero value.
Follow-up windows
The 7-day zero value and the day 8–14 rate are checked across the whole facility group, with the age, People of Determination and pregnancy exemptions applied as written.
Adjusters that do not apply
New-patient status, telemedicine eligibility, age bands and the Centre of Excellence adjuster outside its domain.
Diagnostics billed twice
D-Series lines must sit at zero under a parent visit with a matching ordering clinician, with one M-Series claim per ordering consultation.
Out of scope, billed in scope
Primary care, emergency, daycase and home care carry no ADOC class; encounter types other than outpatient, telemedicine and school-based rehabilitation are rejected.
Audit 360: classify, count, price, document, profile
Classify
Specialty, procedure lines and diagnosis re-mapped to an ADOC class.
Count
Service events rebuilt across lines, days and clinicians.
Price
Seven adjusters and the contracted series multiplier, on DoH draft v1.5 prices.
Document
Requests for the note where an exemption or a monitoring pathway is claimed.
Profile
Provider patterns by class mix, follow-up rate and adjuster use.
ADOC network pricing: four multipliers per provider, priced on your own claims
DoH asks every provider and payer to contract one multiplier per series — P, C, S and M — per provider branch or group and per product, before 1 January 2027. Audit 360 replays your outpatient claims through ADOC and shows what each proposed multiplier costs across the network before contracts close.
- Cost per series for each proposed multiplier, provider by provider
- Where spend moves: bundled diagnostics, follow-up windows, telemedicine and new-patient mix
- Products and branches modelled separately, as the contracting rules allow
E&M audit where fee-for-service continues
From 1 January 2027 specialist outpatient visits in Abu Dhabi bill a C-Series class instead of an E&M level. Outside ADOC, E&M levels are still billed, and still worth auditing.
Primary care
GP and family medicine visits stay outside ADOC and keep billing E&M levels.
Emergency
Emergency department visits are outside the ADOC scope.
The transition
Outpatient claims are paid as fee-for-service until 31 December 2026, including later resubmissions of those claims.
JAWDA data certification
Each level is scored against the note, by medical decision making or time.
Price any ADOC class yourself
The NANO ADOC pricing calculator applies every v1.5 adjuster to any of the 113 classes — the same rules Audit 360 checks claims against.
Your first audited shadow file
Portal access, integration and your first shadow run — within 24 hours of receiving access to your claims files and systems.
Hour zero
Access granted, portal open
You grant access to your claims files and systems; your team signs in to NANO ADOC & E&M Audit 360.
Then
Integrated, re-grouped and priced
Connected to your claims files, Shafafiya XML and your claims system. Every claim is rebuilt into service events, classified and priced on DoH draft v1.5 rules.
Within 24 hours
Your first audited shadow file
Findings by rule, each citing the ADOC rule and the document page it rests on — nothing in your settlement changes.
Claims data is processed and stored in the UAE.
Shadow billing does not change how claims are settled or paid — DoH’s circular on ADOC shadow billing says so.
Questions payers ask about ADOC
What is ADOC?
- ADOC — the Abu Dhabi Outpatient Classification — is the Department of Health – Abu Dhabi’s casemix classification for outpatient care. It pays each outpatient service event by its class instead of by each procedure line. Shadow billing began on 1 July 2026, and ADOC becomes the primary outpatient reimbursement mechanism on 1 January 2027.
What does ADOC mean for insurers and TPAs?
- It moves the audit from lines to events. One class and one price per service event means a wrong class, a missed follow-up rule or a misapplied adjuster overpays a whole event, and four series multipliers per provider have to be contracted before 1 January 2027.
How does ADOC change what we pay for outpatient care?
- You pay one price per service event, built from the class base price, its adjusters and the provider’s series multiplier. The class is where the money moves: C26 Cardiology billed where the evidence supports C03 General medicine costs AED +251.64 more per event, before the multiplier, on DoH draft v1.5 prices.
How do you audit ADOC claims?
- Audit 360 re-groups each claim from its supporting procedure lines, the clinician’s specialty and the diagnosis, rebuilds service events across days, clinicians and facilities, checks every adjuster and follow-up window, and prices the result on DoH draft v1.5 rules. Each finding cites the rule and the document page it rests on.
How are ADOC follow-up visits paid?
- A same-class follow-up within 7 days of the original consultation is zero value; on day 8–14 most consultation classes pay ×0.75. Patients under 18 or over 60, People of Determination and pregnancy-related cases are exempt, and documented new clinical content can make the visit a full event.
Which ADOC adjusters does Audit 360 check?
- All seven: the paediatric and senior age adjusters, new patient (no event in the same class at the same facility in three years), telemedicine, the day 8–14 follow-up adjuster with its exemptions, region, and the Centre of Excellence adjuster, which applies only inside a CoE domain with an eligible diagnosis.
How are ADOC network multipliers set?
- One multiplier per series — P, C, S and M — per provider branch or group, and per product, contracted before 1 January 2027. Audit 360 replays your outpatient claims through ADOC so you can see what each proposed multiplier costs across the network before you sign.
Do we still audit E&M after 1 January 2027?
- Yes, outside ADOC. Specialist outpatient visits in scope bill a C-Series class instead of an E&M level, but primary care and emergency visits stay on fee-for-service with E&M levels, and so do outpatient claims until 31 December 2026. Audit 360 scores each level against the note.
Does shadow billing change how we settle claims this year?
- No. DoH has said shadow billing must not affect claims settlement, payment or approvals. Until 31 December 2026 it is the time to test classification and pricing on real files without touching settlement.
What happens in the first 24 hours?
- Within 24 hours of receiving access to your claims files and systems you get portal access, integration with your claims files, Shafafiya XML and your claims system, and your first audited shadow file. Nothing in your settlement changes.
Draft v1.5 prices for shadow billing only — not for calculating payments.
Per service event, before your series multiplier. Source: Department of Health – Abu Dhabi, ADOC v1.5 Price List · DoH draft v1.5
Book a payer briefing
Tell us about your claims operation and what the audit should cover. A NANO ADOC specialist will contact you.
Portal access, integration and your first shadow run — within 24 hours of receiving access to your claims files and systems.
ADOC is the Abu Dhabi Outpatient Classification of the Department of Health – Abu Dhabi. NANO Health Suite is not affiliated with or endorsed by DoH. Prices shown are DoH draft v1.5 values for shadow billing. DoH Shafafiya prices page (the ADOC v1.5 documents)
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