This profile defines the expected capabilities of a Da Vinci Risk Adjustment Data Submission Client when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Data Submission Clients and Data Submission Servers. Clients are the actors creating and submitting the Risk Adjustment Data Exchange Measure Reports using the $submit-data operation to the Server.

This profile defines the expected capabilities of a Da Vinci Risk Adjustment Data Submission Server when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Clients and Servers. Servers are the actors receiving and processing the Risk Adjustment Data Exchange MeasureReports submitted by the Client.

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.

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.

The ra.evaluate-measure operation is used to evaluate Digital Condition Category and obtain the results.

Search based on the measurereport-category extension

The Patient Group Profile describes a group consisting of one or more patients. It can be used a) when generating risk adjustment gap reports using Bulk FHIR or b) for the evaluated-approach for generating reports as defined on the dCC page.

A Parameters profile that defines structures of multi-part Parameters to be used for sending Condition Category Remarks to a Risk Adjustment Coding Gap Report using the PATCH operation.

This profile is based on the MeasureReport to represent a risk adjustment coding gap report. Payer runs risk adjustment engine and uses this profile to represent the risk adjustment Condition Category (CC) coding gaps and their detailed information for a patient.

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.

This profile is based on the MeasureReport. It is used for Provider to submit data such as clinical evaluation evidence to Payer.

This risk adjustment model measure profile is based on the Measure resource to represent a risk adjustment model and its version, such as CMS-HCC version 24, CMS-HCC version 28.

Indicates the deadline for collecting data to close Condition Category (CC) coding gaps for a risk adjustment model of a measurement period.

The Condition Category Remark extension allows a coded and/or narrative remark be added to a Condition Category (CC) coding gap that is on a Payer generated risk adjustment coding gap report by a provider, an organization, or a software.

Indicates whether the Condition Category (CC) gap is historic or suspected. This extension is also used to indicate if a Condition Category (CC) is net-new.

A coded confidence scale, the degree of certainty, for a Condition Category (CC) coding gap presented in a Payer generated risk adjustment coding gap report.

Diganosis code(s) of the condition, such as ICD-10 codes.

Risk adjustment evidence status date

Indicates whether a Condition Category (CC) coding gap is closed-gap, open-gap, invalid-gap, or pending based on the clinical evidence available for risk adjustment.

This extension identifies which Condition Category (CC) the supporting evidence (represented by MeasureReport.evaluatedResource) is for.

Indicates how hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded.

Unique id of the original payer generated coding gap report. This is the MeasureReport.id from the Risk Adjustment Coding Gap Report profile.

A reference to the vendor who generated the report. The ‘reporting vendor’ is intended to represent the submitting entity when it is not the same as the reporting entity. This extension is used when the Receiver is interested in getting vendor information in the report.

Coded remark for a coding gap.

Type of value-based performance reporting performance metric.

Codes that indicate whether a coding gap is an open-gap, invalid-gap, closed-gap, or pending.

Codes that indicate how hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded.

Codes that describe the confidence scale of a risk adjustment Condition Category (CC).

Reason for the remark

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.

Code sytstem that indicates coded remark for a coding gap.

Reason codes for remark

Code sytstem that indicates whether it is a suspected Condition Category (CC) gap, a historic Condition Category (CC) gap, or a net-new Condition Category (CC). Historic, suspected, and net-new are mutually exclusive.

Code System that indicates whether a coding gap is an open-gap, invalid-gap, closed-gap or pending

Code system that indicates how hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded.

This is a Condition example with code Z93.4: Other artificial openings of gastrointestinal tract status.

This is a Condition example with code E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication.

This is a Condition example with code J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation.

This is a Condition example with code J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation.

This is a Condition example with code E46: Unspecified protein-calorie malnutrition.

This is a Condition example with code K50.119: Crohn’s disease of large intestine with unspecified complications.

This is a Condition example with code I48.19: Other persistent atrial fibrillation.

This is a Condition example with code F31.61: Bipolar disorder, current episode mixed, mild.

This is a Condition example with code B44.81: Allergic bronchopulmonary aspergillosis.

This is a Condition example with code Z79.4: Long term (current) use of insulin.

This is a Condition example with code J81.0: Acute pulmonary edema.

This is a Condition example with code F30.9: Manic episode, unspecified.

This is a Condition example with code E08.22: Diabetes mellitus due to underlying condition with diabetic chronic kidney disease.

This is a Condition example with code Z99.2: Dependence on renal dialysis.

This is a Condition example with code Z68.42: Body mass index [BMI] 45.0-49.9, adult.

This is a Condition example with code I48.11: Longstanding persistent atrial fibrillation.

This is a Condition example with code E11.9: Type 2 diabetes mellitus without complications.

This is a Condition example with code N17.8: Other acute kidney failure.

This is a Condition example with code N18.5: Chronic kidney disease, stage 5.

This is a Condition example with code I48.3: Typical atrial flutter.

This is a Condition example with code I27.82: Chronic pulmonary embolism.

This is a Condition example with code R09.2: Respiratory arrest.

This is a Condition example with code E11.51: Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene.

This is a Condition example with code Z93.4: Other artificial openings of gastrointestinal tract status.

This is a Condition example with code E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication.

This is a Condition example with code B44.81: Allergic bronchopulmonary aspergillosis.

This is a Condition example with code E84.19: Cystic fibrosis with other intestinal manifestations.

This is an example for the Risk Adjustment Data Exchange MeasureReport profile. It evaluatedResource references an example C-CDA document that is being submitted.

This is an Encounter example for encounter with Dr Hippocrates on 2017-01-18 for Patient 01.

This is an Encounter example for encounter with Dr Hippocrates on 2017-02-03 for Patient 03.

This is an Encounter example for encounter with Dr Hippocrates on 2018-07-21 for Patient 01.

This is an Encounter example for encounter with Dr Hippocrates on 2019-02-10 for Patient 01.

This is an Encounter example for encounter with Dr Hippocrates on 2020-11-02 for Patient 03.

This is an Encounter example for encounter with Dr Hippocrates on 2021-01-31 for Patient 03.

This is an Encounter example for encounter with Dr Hippocrates on 2021-03-27 for Patient 03.

This is an Encounter example for encounter with Dr Hippocrates on 2021-09-26 for Patient 03.

This is an Encounter example for encounter with Dr Hippocrates on 2021-10-15 for Patient 01.

This is an Encounter example for encounter with Dr Osler on 2019-02-07 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2019-08-23 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2020-02-10 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2020-03-03 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2020-09-17 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2020-12-18 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2021-01-30 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2021-02-12 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2021-07-01 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2021-07-14 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2021-07-27 for Patient 03.

This is an Encounter example for encounter with Dr Osler on 2021-08-08 for Patient 03.

This is an Encounter example for encounter with Dr Pump on 2021-08-06 for Patient 02.

Laboratory that created lab observations

ABC Payer is an Organization example that generated Risk Adjustment Coding Gap Report.

Best RA Vendor is an Organization example that generated Risk Adjustment Data Exchange MeasureReport.

Community HealthCenter is an Organization example, which is used for example Patient 03 data.

Community Urgent Care is an Organization example, which is used for example Patient 01 data.

GHH Outpatient Clinic is an Organization example, which is used for example Patient 02 data

This is an example Organization that is the author of the RA report

This is an outpatient note example for the US Core DocumentReference Profile.

This is a PHQ9 Total Score for Patient 03.

This is an example using the patch operation to send a Condition Category Remark with data for two Condition Categories (group-001, group-002) and one with multiple attributes: authorDatetime, text.

This is an example using the patch operation to send a Condition Category Remark for one Condition Category (group-001) with one attribute: authorDatetime.

This is an example for the Patient Group profile. This example patient group has one member.

This is an example for the Patient Group profile. This example patient group has two members.

This is an example patient that uses the USCore profile. The example patient name is Eve Everywoman.

This is an example patient that uses the US Core Patient profile. The example patient name is Adam Everyman.

This is an example patient that uses the US Core Patient profile. The example patient name is Nelda Nuclear.

This is an example practitioner that uses the US Core Practitioner profile. The example practitioner is an individual practitioner: Harold Hippocrates.

This is an example practitioner that uses the US Core Practitioner profile. The example practitioner is an organization: GHH Outpatient Clinic.

This is an example practitioner that uses the US Core Practitioner profile. The example practitioner is an organization: Community HealthCenter.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-HCC version 24 as the Risk Adjustment Model and the example patient used is Eve Everywoman.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-RxHCC version 5 as the Risk Adjustment Model and the example patient used is Eve Everywoman.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-HCC version 24 as the Risk Adjustment Model and the example patient used is Eve Everywoman.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-HCC version 21 as the Risk Adjustment Model and the example patient used is Eve Everywoman.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-RxHCC version 5 as the Risk Adjustment Model and the example patient used is Eve Everywoman.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-RxHCC version 5 as the Risk Adjustment Model and the example patient used is Eve Everywoman.

This is an example for the Risk Adjustment Coding Gap MeasureReport profile that shows using the Condition Category Remark extension. The remark is added to MeasureReport.

This is an example for the Risk Adjustment Model Measure profile. The example uses the CMS-HCC version 24 as the example Risk Adjustment Model.

This is an example for the Risk Adjustment Model Measure profile. The example uses the CMS-HCC version 21 as the example Risk Adjustment Model.

This is an example for the Risk Adjustment Model Measure profile. The example uses the CMS-RxHCC version 5 as the example Risk Adjustment Model.

This is an Risk Adjustment MeasureReport Bundle example includes MeasureReport01 for Patient01.

This is an example for Observation. Serum Creatinine for Patient 03 Nelda Nuclear performed at XYZ Laboratory.

This is an example for using $submit-data oepration to send a C-CDA document as supporting evidence using the RA Data Exchange MeasureReport.

Trypsin [Mass/volume] in Serum or Plasma for Patient 01.

This is an example for Observation profile. Trypsin [Mass/volume] in Serum or Plasma for Patient 02 Adam Everyman performed at XYZ Laboratory.