Free tool · ADOC v1.4

ADOC Claim Checker

Describe an outpatient visit in your own words. The checker shows, series by series (P, C, S and D), what ADOC reimburses, what pays nothing, and what is not claimable, with a plain-language reason and the rule behind each answer.

I built this for clinicians and coders in Abu Dhabi, and I am preparing it as open source under the MIT licence so colleagues can add prices, rules and cases. It is provisional. It follows the ADOC v1.4 manuals and published training examples, not the final rules or the official Price List.

New: worked scenarios by specialty, with the reason behind each answer.

Describe the visit

Do not include patient names, ID numbers or dates of birth. Describe the care only. Your description is sent to an AI reader (Anthropic's Claude) that turns it into the lines below. This site does not store it, and the AI makes no billing decision: fixed rules in your browser do.

Try:
Worked examples from the ADOC training

Each loads a stored case straight into the details. No AI reading is used.

Billing answer

What the labels mean

The four series. P = procedures, C = specialist consultations, S = nursing and allied health, D = tests and imaging. P, C and S can be reimbursed; D is always zero value.

Bill
A separate service event. Paid at the ADOC class price.
Reduced rate
A related return on day 8–14 after the original consultation. The first related return in that window pays 50% of the class price for a consultation, and 75% for nursing (S42). Day 1–7 pays nothing, day 15 onwards is a new event at full price, and a genuinely new problem is full price at any time. Day 1 is the consultation day.
Zero value
It pays nothing. It counts as part of another event: a follow-up within 7 days, a procedure included in the consultation fee, or a second class on the same day. You document what you did; the coder decides how it appears on the claim.
Test · zero value
Labs, imaging and other tests. Never paid; they are inputs to the visit that ordered them. The coder reports one line per test class at zero value, linked to the ordering doctor.
Not claimable
Not an outpatient service event under ADOC, for example emergency, admitted or daycase care, a test with no linked visit, or an item billed outside ADOC.
Check
The manuals do not settle it. Confirm with DoH or your coding team.
Five things to check in your note before you close it
  1. Impression and plan. "Patient seen. Continue same." does not show a consultation happened. Write what you assessed and what you decided.
  2. Procedure = its own note. Indication, consent, site/side and technique, findings or specimens, complications (or "none"), aftercare. A one-line "scope done, nil abnormal" in the consultation plan is treated as part of the consultation.
  3. Tests need an indication and must sit under the ordering clinician's name, or they are not counted.
  4. Return visit? Say whether the problem is new, and in one sentence why it is unrelated to the last visit, especially inside the 14-day window.
  5. Say which hat you wore if you are privileged in a second specialty, and make the main focus of a complex consultation obvious.

A longer note does not raise the price. Documentation now decides whether the visit counts, not how much it is worth. If it is not in the record, it did not happen and cannot be billed. Questions on class selection go to your coding team.

Details

This is what the checker read from your description. Change anything here and the answer updates.

Built from the ADOC Definitions Manual and Counting Rules v1.4 and published ADOC training examples. The final rules are not out yet. This tool shows what is reimbursed and what is not. It shows no amounts, because payment depends on the Price List and each facility's contract. Pre-authorisation for diagnostics ordered in an outpatient visit goes away from January 2027. Insurance pre-approval does not change ADOC classification. This is a decision aid, not an official ruling and not a claims adjudicator; figures and rules can change when DoH publishes the final documents. See the site disclaimer.

Send a correction

Spotted a wrong answer, a missing rule, or have Price List or billing-book information? Tell me. No patient names or identifiers, please.

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