Da Vinci Risk Adjustment Implementation Guide
1.0.0 - STU 1
US
Da Vinci Risk Adjustment Implementation Guide
1.0.0 - STU 1
US
This page is part of the Da Vinci Risk Adjustment FHIR Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "MeasureReport",
"id" : "ra-measurereport02",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"ra-measurereport02\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ra-measurereport.html\">Risk Adjustment Coding Gap Report Profile</a></p></div><p><b>Risk Adjustment Clinical Data Collection Deadline Extension</b>: 2022-03-31</p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"Measure-RAModelExample03.html\">Risk Adjustment Model Version 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-HCC)</a></p><p><b>subject</b>: <a href=\"Patient-ra-patient01.html\">Patient/ra-patient01</a> \" EVERYWOMAN\"</p><p><b>date</b>: 2021-10-18</p><p><b>reporter</b>: <a href=\"Organization-ra-payer01.html\">Organization/ra-payer01</a> \"ABC Payer\"</p><p><b>period</b>: 2021-01-01 --> 2021-09-30</p><blockquote><p><b>group</b></p><p><b>Risk Adjustment Suspect Type Extension</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type Code System</a>#historic)</span></p><p><b>Evidence Status Extension</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status Code System</a>#closed-gap)</span></p><p><b>Risk Adjustment Evidence Status Date Extension</b>: 2021-04-01</p><p><b>Hierarchical Status Extension</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status Code System</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 227: Pulmonary Fibrosis and Other Chronic Lung Disorders <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#227 \"Pulmonary Fibrosis and Other Chronic Lung Disorders\")</span></p></blockquote><blockquote><p><b>group</b></p><p><b>Risk Adjustment Suspect Type Extension</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type Code System</a>#historic)</span></p><p><b>Evidence Status Extension</b>: Open Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status Code System</a>#open-gap)</span></p><p><b>Risk Adjustment Evidence Status Date Extension</b>: 2020-07-01</p><p><b>Hierarchical Status Extension</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status Code System</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 131: Bipolar Disorders <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#131 \"Bipolar Disorders\")</span></p></blockquote><blockquote><p><b>group</b></p><p><b>Risk Adjustment Suspect Type Extension</b>: Suspected Condtion Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type Code System</a>#suspected)</span></p><p><b>Evidence Status Extension</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status Code System</a>#closed-gap)</span></p><p><b>Risk Adjustment Evidence Status Date Extension</b>: 2021-02-15</p><p><b>Hierarchical Status Extension</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status Code System</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 30: Diabetes with Chronic Complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#30 \"Diabetes with Chronic Complications\")</span></p></blockquote><blockquote><p><b>group</b></p><p><b>Risk Adjustment Suspect Type Extension</b>: Suspected Condtion Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type Code System</a>#suspected)</span></p><p><b>Risk Adjustment Evidence Status Date Extension</b>: 2021-04-01</p><p><b>Evidence Status Extension</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status Code System</a>#closed-gap)</span></p><p><b>Hierarchical Status Extension</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status Code System</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 43: Morbid Obesity <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#43 \"Morbid Obesity\")</span></p></blockquote><blockquote><p><b>group</b></p><p><b>Risk Adjustment Suspect Type Extension</b>: Suspected Condtion Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type Code System</a>#suspected)</span></p><p><b>Evidence Status Extension</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status Code System</a>#pending)</span></p><p><b>Risk Adjustment Evidence Status Date Extension</b>: 2021-09-29</p><p><b>Hierarchical Status Extension</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status Code System</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 31: Diabetes without Complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#31 \"Diabetes without Complications\")</span></p></blockquote><blockquote><p><b>group</b></p><p><b>Risk Adjustment Suspect Type Extension</b>: Net-New Condition Category <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type Code System</a>#net-new)</span></p><p><b>Evidence Status Extension</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status Code System</a>#pending)</span></p><p><b>Risk Adjustment Evidence Status Date Extension</b>: 2021-09-29</p><p><b>Hierarchical Status Extension</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status Code System</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#226 \"Chronic Obstructive Pulmonary Disease and Asthma\")</span></p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Condition-ra-condition09pat01.html\">Condition/ra-condition09pat01</a></li><li><a href=\"Condition-ra-condition08pat01.html\">Condition/ra-condition08pat01</a></li><li><a href=\"Condition-ra-condition02pat01.html\">Condition/ra-condition02pat01</a></li><li><a href=\"Condition-ra-condition17pat01.html\">Condition/ra-condition17pat01</a></li><li><a href=\"Condition-ra-condition10pat01.html\">Condition/ra-condition10pat01</a></li><li><a href=\"Condition-ra-condition03pat01.html\">Condition/ra-condition03pat01</a></li><li><a href=\"Condition-ra-condition44pat01.html\">Condition/ra-condition44pat01</a></li><li><a href=\"Encounter-ra-encounter09pat01.html\">Encounter/ra-encounter09pat01</a></li><li><a href=\"Encounter-ra-encounter08pat01.html\">Encounter/ra-encounter08pat01</a></li><li><a href=\"Encounter-ra-encounter02pat01.html\">Encounter/ra-encounter02pat01</a></li><li><a href=\"Encounter-ra-encounter03pat01.html\">Encounter/ra-encounter03pat01</a></li><li><a href=\"Encounter-ra-encounter45pat01.html\">Encounter/ra-encounter45pat01</a></li></ul></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline",
"valueDate" : "2022-03-31"
}
],
"status" : "complete",
"type" : "individual",
"measure" : "https://build.fhir.org/ig/HL7/davinci-ra/Measure-RAModelExample03",
"subject" : {
"reference" : "Patient/ra-patient01"
},
"date" : "2021-10-18",
"reporter" : {
"reference" : "Organization/ra-payer01"
},
"period" : {
"start" : "2021-01-01",
"end" : "2021-09-30"
},
"group" : [
{
"id" : "group-001",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "historic"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-04-01"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "227",
"display" : "Pulmonary Fibrosis and Other Chronic Lung Disorders"
}
],
"text" : "CMS-RxHCC 227: Pulmonary Fibrosis and Other Chronic Lung Disorders"
}
},
{
"id" : "group-002",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "historic"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "open-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2020-07-01"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "131",
"display" : "Bipolar Disorders"
}
],
"text" : "CMS-RxHCC 131: Bipolar Disorders"
}
},
{
"id" : "group-003",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-02-15"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "30",
"display" : "Diabetes with Chronic Complications"
}
],
"text" : "CMS-RxHCC 30: Diabetes with Chronic Complications"
}
},
{
"id" : "group-004",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-04-01"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "43",
"display" : "Morbid Obesity"
}
],
"text" : "CMS-RxHCC 43: Morbid Obesity"
}
},
{
"id" : "group-005",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "pending"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-09-29"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "31",
"display" : "Diabetes without Complications"
}
],
"text" : "CMS-RxHCC 31: Diabetes without Complications"
}
},
{
"id" : "group-006",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "net-new"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "pending"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-09-29"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "226",
"display" : "Chronic Obstructive Pulmonary Disease and Asthma"
}
],
"text" : "CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma"
}
}
],
"evaluatedResource" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Condition/ra-condition09pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-002"
}
],
"reference" : "Condition/ra-condition08pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-003"
}
],
"reference" : "Condition/ra-condition02pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-004"
}
],
"reference" : "Condition/ra-condition17pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-005"
}
],
"reference" : "Condition/ra-condition10pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-006"
}
],
"reference" : "Condition/ra-condition03pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Condition/ra-condition44pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Encounter/ra-encounter09pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-002"
}
],
"reference" : "Encounter/ra-encounter08pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-003"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-004"
}
],
"reference" : "Encounter/ra-encounter02pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-005"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-006"
}
],
"reference" : "Encounter/ra-encounter03pat01"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Encounter/ra-encounter45pat01"
}
]
}
IG © 2021+ HL7 Clinical Quality Information Work Group. Package hl7.fhir.us.davinci-ra#1.0.0 based on FHIR 4.0.1. Generated 2022-06-16
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