1. Dubai Health Authority IR DRG Event 12 December, 2016

2. How to read the IR-DRG number
1st two digits – MDC
3rd digit – DRG Type
4th & 5th digit – uniqe DRG number given the particular MDC & DRG type combination
6th Digit – SOI Subclass
Optional – 7th ROM subclass, appears after the DRG itself

3. MBDS Unique patient identifier
Birth Date or Age in years (if 0 year old : age in days)
Encounter identifier
Admit-Discharge Date
Provider Organization/ Responsible physician
Location of service
Encounter Type
Discharge Status
Principal Diagnosis
Secondary diagnoses
Activities - Interventions/procedures
Patient Weight – if age < 8 days on admission (newborns & neonates)
IR-DRG Code
IR DRG ALOS (not submitted on claim )
High Trim (not submitted on claim )
Low Trim (not submitted on claim )
Severity of Illness (SOI
Risk of Mortality (ROM)
Present on Admission (POA) indicator

4. Example of a Grouped Encounter

5. Example 2

6. eClaimLink Updates

7. New Fields
DxInfoType – The type of additional information for the diagnosis
The field is mandatory, with default value = POA Present on Admission
DxInfoCode – Value indicating the POA status
Y= Yes, N = No, U= Unknown, W= Clinically Undetermined, 1= Unreported/Not used, OP= Outpatient claim.
Full definitions of the values are available in the eClaimLink schema CommonTypes, XSD and Sample
OP transactions do not require DRGs at this time.
CommonTypes
CommonTypes
XSD
CS Sample

8. New Fields
Patient Weight - Required for newborn and neonate encounters.
Age on admission is 7 days or less
Ex: A baby born on 1 October (day 0) remains a neonate until completion of 7 days on 8 October and is no longer a neonate on 9 October.
CommonTypes
XSD

9. Updated fields/definitions
ActivityType – a new type was added to accommodate the DRG code.
Type 9: DRG
A predefined list of DRG codes as published on the eClaimLink website.
ObservationType – two new observation types are added to accommodate the DRG related details
Type 1: ROM = Risk of Mortality
This is based on the primary and secondary diagnosis and it is supplied by the DRG grouper along with the DRG code
Possible values = 1, 2, 3
Type 2: ExcludeFromDRG
This is used to indicate that an activity from the DRG will not be claimed from insurance

10. ClaimSubmission Sample
All activities should be listed with Net = amount requested from the payer
The DRG activity should be listed with Net = 0
DRG code
Diagnosis
Granular activities

11. Q & A
Regulatory – Data – Grouper – eClaimLink –