Abu Dhabi's DOH Claims and Adjudication Rules V2025.1

The Department of Health – Abu Dhabi publishes its Claims and Adjudication Rules, with version V2025.1 incorporating the Mandatory Tariff Pricelist application rules. These rules define how claims are priced and adjudicated across Abu Dhabi providers.

IR-DRGs are mandated for all inpatient encounters. Under the prospective payment model, payment is inclusive of the procedures, services, consumables and devices used in a single inpatient encounter, with activities reported under a fee-for-service methodology and Activity.Net set to zero except for the IR-DRG code and the outlier service code.

Through 2025 the DOH also issued addenda — updates to inpatient relative weights, a new stroke payment model, mental-health relative weights and LAMA payment calculation — each with its own effective date, which coding and billing teams must track.

Keeping the right rule version against each claim's service date is exactly the kind of check DataHub's resubmission intelligence is designed to surface before a claim reaches production.