Da Vinci Risk Adjustment Implementation Guide
2.0.0 - STU2 United States of America flag

Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

Resource Profile: Risk Adjustment Coding Gap MeasureReport

Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport Version: 2.0.0
Active as of 2024-03-28 Computable Name: RiskAdjustmentCodingGapMeasureReport

Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License

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.

Mandatory Data Elements and Terminology

The following data-elements must always be present (Mandatory) or must be supported (Must Support). The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MeasureReport must have:

  1. A MeasureReport.status element
  2. A MeasureReport.type element hard coded to “individual”
  3. A MeasureReport.measure element references a Risk Adjustment Model Measure
  4. A MeasureReport.subject element references a US Core Patient profile
  5. A MeasureReport.period element for the clinical evaluation period for which the risk adjustment coding gap report was generated.

Each MeasureReport should have ([Must Support]):

  1. Zero to many MeasureReport.group element
  2. Each MeasureReport.group should have a MeasureReport.group.code element
  3. Each MeasureReport.group should have a MeasureReport.group.suspectType element
  4. Each MeasureReport.group should have a MeasureReport.group.evidenceStatus element
  5. Each MeasureReport.group should have a MeasureReport.group.evidenceStatusDate element
  6. Each MeasureReport.group should have a MeasureReport.group.hierarchicalStatus element
  7. Each MeasureReport.group should have zero to many MeasureReport.evalautedResource element

Each MeasureReport may have ([Must Support]):

  1. Each MeasureReport.group may have zero to one MeasureReport.group.confidenceScale element
  2. Each MeasureReport.group may have zero to many MeasureReport.group.ccRemark element

Additional Profile specific implementation guidance:

  1. evaluatedResource SHALL reference resources using USCore profiles where applicable

The Clinical Data Collection Deadline element, clinicalDataCollectionDeadline, was added as an extension to MeasureReport. We are seeking comment from implementers if they intend to use this element when communicating risk adjustment coding gap reports from payers to providers.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MeasureReport

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport 0..*MeasureReportThis is a risk adjustment coding gap report.
... clinicalDataCollectionDeadline S0..1dateThis is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
... status S1..1codecomplete | pending | error
... type S1..1codeThe type code is fixed to 'individual' for a risk adjustment coding gap report
Fixed Value: individual
... subject S1..1Reference(US Core Patient Profile)What individual(s) the report is for
... date S1..1dateTimeWhen the report was generated
... reporter S1..1Reference(US Core Organization Profile)Organization that generated the MeasureReport
... period SC1..1PeriodClinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start S1..1dateTimeStarting time with inclusive boundary
.... end S1..1dateTimeEnd time with inclusive boundary, if not ongoing
... group S0..*BackboneElementA group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
.... id S1..1stringUnique id for inter-element referencing
.... suspectType S0..1CodeableConcepthistoric|suspected|net-new
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
Binding: Risk Adjustment Suspect Type ValueSet (extensible)
.... evidenceStatus S0..1CodeableConceptThis is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
Binding: Risk Adjustment Evidence Status ValueSet (extensible)
.... evidenceStatusDate S0..1dateWhen the evidence status was changed to either closed-gap, open-gap, or pending
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
.... hierarchicalStatus S0..1CodeableConceptHow hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
.... confidenceScale S0..1CodeableConceptConfidence scale for a coding gap
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
Binding: Confidence Scale Value Set (extensible)
.... ccRemark S0..*(Complex)Remark added to a Condition Category
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
.... code S0..1CodeableConceptCondition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
.... stratifier
..... code 0..1CodeableConceptWhat stratifier of the group
... evaluatedResource S0..*Reference(Resource)An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
.... groupReference S0..*stringThis references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9
NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C0..*MeasureReportThis is a risk adjustment coding gap report.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... clinicalDataCollectionDeadline S0..1dateThis is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... type SΣC1..1codeThe type code is fixed to 'individual' for a risk adjustment coding gap report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: individual
... measure SΣ1..1canonical(Risk Adjustment Model Measure)This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
... subject SΣ1..1Reference(US Core Patient Profile)What individual(s) the report is for
... date SΣ1..1dateTimeWhen the report was generated
... reporter SΣ1..1Reference(US Core Organization Profile)Organization that generated the MeasureReport
... period SΣC1..1PeriodClinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end SΣC1..1dateTimeEnd time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ0..1CodeableConceptincrease | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC0..*BackboneElementA group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
.... id S1..1stringUnique id for inter-element referencing
.... suspectType S0..1CodeableConcepthistoric|suspected|net-new
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
Binding: Risk Adjustment Suspect Type ValueSet (extensible)
.... evidenceStatus S0..1CodeableConceptThis is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
Binding: Risk Adjustment Evidence Status ValueSet (extensible)
.... evidenceStatusDate S0..1dateWhen the evidence status was changed to either closed-gap, open-gap, or pending
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
.... hierarchicalStatus S0..1CodeableConceptHow hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
.... confidenceScale S0..1CodeableConceptConfidence scale for a coding gap
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
Binding: Confidence Scale Value Set (extensible)
.... ccRemark S0..*(Complex)Remark added to a Condition Category
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ0..1CodeableConceptCondition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
... evaluatedResource S0..*Reference(Resource)An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
.... groupReference S0..*stringThis references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: individual
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9
NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C0..*MeasureReportThis is a risk adjustment coding gap report.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... clinicalDataCollectionDeadline S0..1dateThis is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierAdditional identifier for the MeasureReport
... status ?!SΣ1..1codecomplete | pending | error
Binding: MeasureReportStatus (required): The status of the measure report.

... type SΣC1..1codeThe type code is fixed to 'individual' for a risk adjustment coding gap report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: individual
... measure SΣ1..1canonical(Risk Adjustment Model Measure)This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
... subject SΣ1..1Reference(US Core Patient Profile)What individual(s) the report is for
... date SΣ1..1dateTimeWhen the report was generated
... reporter SΣ1..1Reference(US Core Organization Profile)Organization that generated the MeasureReport
... period SΣC1..1PeriodClinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end SΣC1..1dateTimeEnd time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ0..1CodeableConceptincrease | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC0..*BackboneElementA group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
.... id S1..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... suspectType S0..1CodeableConcepthistoric|suspected|net-new
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
Binding: Risk Adjustment Suspect Type ValueSet (extensible)
.... evidenceStatus S0..1CodeableConceptThis is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
Binding: Risk Adjustment Evidence Status ValueSet (extensible)
.... evidenceStatusDate S0..1dateWhen the evidence status was changed to either closed-gap, open-gap, or pending
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
.... hierarchicalStatus S0..1CodeableConceptHow hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
.... confidenceScale S0..1CodeableConceptConfidence scale for a coding gap
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
Binding: Confidence Scale Value Set (extensible)
.... ccRemark S0..*(Complex)Remark added to a Condition Category
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ0..1CodeableConceptCondition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
.... population 0..*BackboneElementThe populations in the group
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code Σ0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

..... count 0..1integerSize of the population
..... subjectResults 0..1Reference(List)For subject-list reports, the subject results in this population
.... measureScore Σ0..1QuantityWhat score this group achieved
.... stratifier 0..*BackboneElementStratification results
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code 0..1CodeableConceptWhat stratifier of the group
..... stratum 0..*BackboneElementStratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value 0..1CodeableConceptThe stratum value, e.g. male
...... component 0..*BackboneElementStratifier component values
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... code 1..1CodeableConceptWhat stratifier component of the group
....... value 1..1CodeableConceptThe stratum component value, e.g. male
...... population 0..*BackboneElementPopulation results in this stratum
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... code 0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

....... count 0..1integerSize of the population
....... subjectResults 0..1Reference(List)For subject-list reports, the subject results in this population
...... measureScore 0..1QuantityWhat score this stratum achieved
... evaluatedResource S0..*Reference(Resource)An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... groupReference S0..*stringThis references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: individual
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG
MeasureReport.group.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.group.stratifier.stratum.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.evaluatedResource.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

Differential View

This structure is derived from MeasureReport

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport 0..*MeasureReportThis is a risk adjustment coding gap report.
... clinicalDataCollectionDeadline S0..1dateThis is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
... status S1..1codecomplete | pending | error
... type S1..1codeThe type code is fixed to 'individual' for a risk adjustment coding gap report
Fixed Value: individual
... subject S1..1Reference(US Core Patient Profile)What individual(s) the report is for
... date S1..1dateTimeWhen the report was generated
... reporter S1..1Reference(US Core Organization Profile)Organization that generated the MeasureReport
... period SC1..1PeriodClinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start S1..1dateTimeStarting time with inclusive boundary
.... end S1..1dateTimeEnd time with inclusive boundary, if not ongoing
... group S0..*BackboneElementA group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
.... id S1..1stringUnique id for inter-element referencing
.... suspectType S0..1CodeableConcepthistoric|suspected|net-new
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
Binding: Risk Adjustment Suspect Type ValueSet (extensible)
.... evidenceStatus S0..1CodeableConceptThis is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
Binding: Risk Adjustment Evidence Status ValueSet (extensible)
.... evidenceStatusDate S0..1dateWhen the evidence status was changed to either closed-gap, open-gap, or pending
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
.... hierarchicalStatus S0..1CodeableConceptHow hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
.... confidenceScale S0..1CodeableConceptConfidence scale for a coding gap
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
Binding: Confidence Scale Value Set (extensible)
.... ccRemark S0..*(Complex)Remark added to a Condition Category
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
.... code S0..1CodeableConceptCondition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
.... stratifier
..... code 0..1CodeableConceptWhat stratifier of the group
... evaluatedResource S0..*Reference(Resource)An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
.... groupReference S0..*stringThis references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C0..*MeasureReportThis is a risk adjustment coding gap report.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... clinicalDataCollectionDeadline S0..1dateThis is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... type SΣC1..1codeThe type code is fixed to 'individual' for a risk adjustment coding gap report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: individual
... measure SΣ1..1canonical(Risk Adjustment Model Measure)This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
... subject SΣ1..1Reference(US Core Patient Profile)What individual(s) the report is for
... date SΣ1..1dateTimeWhen the report was generated
... reporter SΣ1..1Reference(US Core Organization Profile)Organization that generated the MeasureReport
... period SΣC1..1PeriodClinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end SΣC1..1dateTimeEnd time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ0..1CodeableConceptincrease | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC0..*BackboneElementA group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
.... id S1..1stringUnique id for inter-element referencing
.... suspectType S0..1CodeableConcepthistoric|suspected|net-new
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
Binding: Risk Adjustment Suspect Type ValueSet (extensible)
.... evidenceStatus S0..1CodeableConceptThis is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
Binding: Risk Adjustment Evidence Status ValueSet (extensible)
.... evidenceStatusDate S0..1dateWhen the evidence status was changed to either closed-gap, open-gap, or pending
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
.... hierarchicalStatus S0..1CodeableConceptHow hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
.... confidenceScale S0..1CodeableConceptConfidence scale for a coding gap
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
Binding: Confidence Scale Value Set (extensible)
.... ccRemark S0..*(Complex)Remark added to a Condition Category
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ0..1CodeableConceptCondition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
... evaluatedResource S0..*Reference(Resource)An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
.... groupReference S0..*stringThis references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: individual
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C0..*MeasureReportThis is a risk adjustment coding gap report.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... clinicalDataCollectionDeadline S0..1dateThis is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierAdditional identifier for the MeasureReport
... status ?!SΣ1..1codecomplete | pending | error
Binding: MeasureReportStatus (required): The status of the measure report.

... type SΣC1..1codeThe type code is fixed to 'individual' for a risk adjustment coding gap report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: individual
... measure SΣ1..1canonical(Risk Adjustment Model Measure)This references a measure that represents a risk adjustment model, such as CMS-HCC V24.
... subject SΣ1..1Reference(US Core Patient Profile)What individual(s) the report is for
... date SΣ1..1dateTimeWhen the report was generated
... reporter SΣ1..1Reference(US Core Organization Profile)Organization that generated the MeasureReport
... period SΣC1..1PeriodClinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end SΣC1..1dateTimeEnd time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ0..1CodeableConceptincrease | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC0..*BackboneElementA group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
.... id S1..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... suspectType S0..1CodeableConcepthistoric|suspected|net-new
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType
Binding: Risk Adjustment Suspect Type ValueSet (extensible)
.... evidenceStatus S0..1CodeableConceptThis is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|pending.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus
Binding: Risk Adjustment Evidence Status ValueSet (extensible)
.... evidenceStatusDate S0..1dateWhen the evidence status was changed to either closed-gap, open-gap, or pending
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
.... hierarchicalStatus S0..1CodeableConceptHow hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus
Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
.... confidenceScale S0..1CodeableConceptConfidence scale for a coding gap
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale
Binding: Confidence Scale Value Set (extensible)
.... ccRemark S0..*(Complex)Remark added to a Condition Category
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣ0..1CodeableConceptCondition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
.... population 0..*BackboneElementThe populations in the group
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code Σ0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

..... count 0..1integerSize of the population
..... subjectResults 0..1Reference(List)For subject-list reports, the subject results in this population
.... measureScore Σ0..1QuantityWhat score this group achieved
.... stratifier 0..*BackboneElementStratification results
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code 0..1CodeableConceptWhat stratifier of the group
..... stratum 0..*BackboneElementStratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... value 0..1CodeableConceptThe stratum value, e.g. male
...... component 0..*BackboneElementStratifier component values
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... code 1..1CodeableConceptWhat stratifier component of the group
....... value 1..1CodeableConceptThe stratum component value, e.g. male
...... population 0..*BackboneElementPopulation results in this stratum
....... id 0..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... code 0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

....... count 0..1integerSize of the population
....... subjectResults 0..1Reference(List)For subject-list reports, the subject results in this population
...... measureScore 0..1QuantityWhat score this stratum achieved
... evaluatedResource S0..*Reference(Resource)An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... groupReference S0..*stringThis references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: individual
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG
MeasureReport.group.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.group.stratifier.stratum.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.evaluatedResource.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

 

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