Da Vinci Risk Adjustment Implementation Guide
2.0.0-ballot - STU2 Ballot
Da Vinci Risk Adjustment Implementation Guide
2.0.0-ballot - STU2 Ballot
This page is part of the Da Vinci Risk Adjustment FHIR Implementation Guide (v2.0.0-ballot: STU2 (v2.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions 
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.
| Risk Adjustment Remediation Client Capability Statement |
This profile defines the expected capabilities of a Da Vinci Risk Adjustment Remediation Client when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Remediation Clients and Remediation Servers. Clients are the actors making the request for remediating Risk Adjustment coding gaps for Risk Adjustment Coding Gap Reports of patient(s) that are available on the Server. |
| Risk Adjustment Remediation Server Capability Statement |
This profile defines the expected capabilities of a Da Vinci Risk Adjustment Remediation Server when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Clients and Servers. Servers are the actors receiving the request for Risk Adjustment coding gaps remediation for Risk Adjustment Coding Gap Reports of patients that are available on the Server. |
| Risk Adjustment Reporting Client Capability Statement |
This profile defines the expected capabilities of a Da Vinci Risk Adjustment Reporting Client when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Reporting Clients and Reporting Servers. Clients are the actors making the request for Risk Adjustment Coding Gap Reports for patient(s) and for Risk Adjustmenet Models that are available on the Server. This CapabilityStatement resource includes the complete list of the recommended Da Vinci Risk Adjustment profiles and RESTful operations that a Risk Adjustment Reporting Client could support. Clients have the option of choosing from this list based on their local use cases and other contextual requirements. |
| Risk Adjustment Reporting Server Capability Statement |
This profile defines the expected capabilities of a Da Vinci Risk Adjustment Reporting Server when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Reporting Clients and Reporting Servers. Servers are the actors receiving the request for Risk Adjustment Coding Gap Reports for patient(s) and for Risk Adjustmenet Models that are available on the Server. This CapabilityStatement resource includes the complete list of the recommended Da Vinci Risk Adjustment profiles and RESTful operations that a Risk Adjustment Reporting Server could support. Servers have the option of choosing from this list based on their local use cases and other contextual requirements. |
These are custom operations that can be supported by and/or invoked by systems conforming to this implementation guide.
| Evaluate Measure |
The ra.evaluate-measure operation is used to evaluate Digital Condition Category and obtain the results. |
These define constraints on FHIR resources for systems conforming to this implementation guide.
| Risk Adjustment Clinical Evaluation Evidence Task |
This Task profile is used to support the risk adjustment coding gap remediation process. |
| Risk Adjustment Coding Gap Report Bundle |
The Risk Adjustment Coding Gap Report Bundle Profile describes a collection bundle returned by the $ra.evaluate-measure operation. This bundle is a collection of Risk Adjustment Coding Gap Reports. |
| Risk Adjustment Coding Gap MeasureReport |
This profile is based on the MeasureReport to represent a risk adjustment coding gap report. |
| Risk Adjustment Model Measure |
This risk adjustment model measure profile is based on the Measure resoure to represent a risk adjustment model and its version such as CMS-HCC version 24. |
| Patient Group |
The Patient Group Profile describes a group consisting of one or more patients. |
| Risk Adjustment SearchSet Bundle |
A SearchSet Bundle with entries that include resources for risk adjustment coding gap clinical evaluation evidence and the fullUrl of the resource. |
These define constraints on FHIR data types for systems conforming to this implementation guide.
| Annotation |
Annotation |
| Risk Adjustment Clinical Data Collection Deadline |
Risk Adjustment Clinical Data Collection Deadline |
| Confidence Scale |
Confidence scale for a Condition Category (CC) coding gap. |
| Evidence Status |
Evidence status of a Condition Category (CC) coding gap, which is closed-gap, open-gap, or pending. |
| Risk Adjustment Evidence Status Date |
Risk adjustment evidence status date |
| Group Reference |
This extension identifies which Condition Category (CC) gap the supporting evidence (represented by |
| Hierarchical Status |
This extension is to indicate if hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded. |
| Risk Adjustment Suspect Type |
Risk adjustment suspect type |
These define sets of codes used by systems conforming to this implementation guide.
| Coding Gap Annotation |
Coded annotation for a coding gap |
| Coding Gap Task Reason ValueSet |
Risk adjustment clinical evaluation evidence task reason |
| Coding Gap Task Status ValueSet |
Task status codes for use to support risk adjustment coding gap reconciliation |
| Confidence Scale Value Set |
This describes confidence scale of a risk adjustment coding gap. |
| Risk Adjustment Evidence Status ValueSet |
Concepts for risk adjustment evidence status |
| Risk Adjustment Hierarchical Status ValueSet |
Risk adjustment hierarchical status |
| Sample CMS Hierarchical Condition Category |
This is a sample of the concepts that can be found in the CMS Hierarchical Condition Categories (CMS-HCC) code system version 24. The source of the codes included in this example was published at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2020.pdf. The CMS-HCC model uses more than 9,000 ICD-10-CM codes, which are mapped to condition categories (CCs) that predict costs well. The condition categories (CCs) are based on diagnoses clinically related to one another and with similar predicted cost implications. Hierarchies are imposed on the Condition Categories (CCs) to capture the most costly diagnoses. Hierarchy logic is imposed on certain Condition Categories (CCs) to account for different hierarchical costs, thus, the term Hierarchical Condition Category, or HCC. |
| Risk Adjustment Suspect Type ValueSet |
Risk adjustment suspect type |
These define new code systems used by systems conforming to this implementation guide.
| Coding Gap Annotation CodeSystem |
Coded annotation for coding gap |
| Coding Gap Task Reason CodeSystem |
Risk adjustment clinical evaluation evidence task reason |
| Risk Adjustment Evidence Status CodeSystem |
Indicates whether a coding gap is an open-gap, invalid-gap, closed-gap, or pending. |
| Risk Adjustment Hierarchical Status CodeSystem |
Indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded. |
| Risk Adjustment Suspect Type CodeSystem |
Risk Adjustment suspect type indicates whether it is a suspected Condition Category (CC) gap, a historic Condition Category (CC) gap, or an unsuspected Condition Category (CC). Historic, suspected, and net-new are mutually exclusive. |
| Task Label CodeSystem |
Label of task input or output. |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
IG © 2021+ HL7 Clinical Quality Information Work Group. Package hl7.fhir.us.davinci-ra#2.0.0-ballot based on FHIR 4.0.1. Generated 2023-03-28
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