DRG/System provides inpatient ICD-10-CM code editing, DRG grouping, Medicare reimbursement calculation and outpatient Medicare Ambulatory Payment Classification System (APC) support. Including New York State and all previous Medicare approved groupers, DRG/System selects the proper grouper, reimbursement formula and code edits by patient discharge date.

Extensive edits identify incomplete or inconsistent coding and cases where DRG assignment, reimbursement might be improved by additional analysis. All valid DRGs are presented in descending weight order to assist in selection of most appropriate principal diagnosis in questionable cases. Upon completion of grouping functions, procedures and diagnoses are automatically reordered to correct UB-04 format.

DRG/System supports multi-provider and multi-payor environments, allows selective disabling of individual edits and runs in either batch or on-line mode. DRG/System will compute Medicare payments for all U.S. hospitals. ICD-10 & ICD-9 Ready. DRG/System; is a trademark of nThrive®, Inc.

Business information

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  • Functional details

    Provide a full range of support for hospitals and insurance companies to manage the payment and adjudication process for inpatient and outpatient claims. Client customizable modules provide enhanced Medicare based pricing, or simplified pricing, extremely time efficient for Business Analysts and Project Managers.

    The ICD-10 and ICD-9 Code Set remapping functions allow coders to use the ICD-10 code set with the current and older groupers.

  • Business problem

    Establish contracted patient payment rates for your demographic group using CMS rates and claims experience.

  • Business opportunity

    Ensures that claims processing is compliant with applicable Federal rules.  

    Reduce patient claim errors and standardize payment for all CMS hospital facilities using Medicare and Medicaid payment models and rules.

  • Return on investment

    Reduce your startup costs to minimal integration and implementation time. Data is easily converted into database form for further analysis.Production cycles with millions of claims are processed within short time windows.

  • Competitive advantage

    Frequent updates ensure compliance with Federal regulations. Bundling the solution to include previous groupers has allowed us to stay ahead of the future ICD-10 needs for our clients. The solution integrates with the I-OCE Grouper & Pricer for Michigan, Wisconsin ASC and APC pricing. The DRG System also prices Psychiatric, Long Term, APR and AP clams.

  • Industries

    Healthcare Industry
    Insurance Industry

  • Solution areas

    Healthcare and Pharmaceutical
       Administrative Systems
       Finance and Accounting
       Operations and Regulations
       Payer Transaction Services
       Physician Office Automation
          Claims administration
          Health information systems
       Administration Systems and Services
          Claims Administration

  • Customer size

    Midmarket Business (100 to 499 employees)
    Midmarket Business (500 to 1000 employees)
    Large Business (greater than 1000 employees)

  • Languages supported


  • Countries/regions available for distribution

    Puerto Rico , United States

Technical information

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  • Hardware/OS platforms

       Hewlett-Packard servers (incl. Compaq)
       IBM Systems: z Systems
    IBM i 6.1
       IBM Systems: Power
    Windows Server 2008 (inclusive)
       IBM BladeCenter HSxx (Intel processor-based)
    z/OS 1.12
       IBM Systems: z Systems

  • Services

    Custom Systems Integration Services

Date last modified:    Oct 11, 2017


Contact information

Jim Kelleher


nThrive Revenue Systems, LLC
209 Burlington Road
Suite 111
Bedford, MA 01730
United States

+1 800 6340496

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