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 in its permanent home (it will always be available at this URL). 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 Server Capability Statement |
This profile defines the expected capabilities of a Da Vinci Risk Adjustment 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 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 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
| Report Operation |
Generate a measure report |
These define constraints on FHIR resources for systems conforming to this implementation guide
| Risk Adjustment Coding Gap Report Bundle Profile |
The Risk Adjustment Coding Gap Report Bundle Profile describes a collection bundle returned by the report operation. This bundle is a collection of Risk Adjustment Coding Gap Reports. |
| Risk Adjustment Coding Gap Report Profile |
This risk adjustment coding gap report 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 Profile |
The Patient Group Profile describes a group consisting of one or more patients. |
These define constraints on FHIR data types for systems conforming to this implementation guide
| Risk Adjustment Clinical Data Collection Deadline Extension |
Risk Adjustment Clinical Data Collection Deadline Extension |
| Evidence Status Extension |
This extension is for evidence status of a Condition Category (CC) coding gap, which is closed-gap, open-gap, or pending. |
| Risk Adjustment Evidence Status Date Extension |
Risk Adjustment Evidence Status Date Extension |
| Group Reference Extension |
This extension identifies which Condition Category (CC) gap the supporting evidence (represented by |
| Hierarchical Status Extension |
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 Extension |
Risk Adjustment Suspect Type Extension |
These define sets of codes used by systems conforming to this implementation guide
| Risk Adjustment Evidence Status Value Set |
Concepts for risk adjustment evidence status |
| Example CMS Hierarchical Condition Category Value Set |
This is an example value set with concepts drawn from the CMS Hierarchical Condition Categories (CMS-HCC) code system version 24. The source of the codes included in this example value set is published on 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 Hierarchical Status Value Set |
Concepts for risk adjustment hierarchical status |
| Risk Adjustment Suspect Type Value Set |
Concepts for risk adjustment suspect type |
These define new code systems used by systems conforming to this implementation guide
| Risk Adjustment Evidence Status Code System |
This is a code system for Risk Adjustment evidence status to indicate whether a Condition Category (CC) gap is open-gap, closed-gap, or pending. |
| Risk Adjustment Hierarchical Status Code System |
This is a code system for Risk Adjustment Hierarchical Status to indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded. |
| Risk Adjustment Suspect Type Code System |
This is a code system for Risk Adjustment suspect type to indicate 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. |
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#1.0.0 based on FHIR 4.0.1. Generated 2022-06-16
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