Da Vinci Risk Adjustment Implementation Guide
2.0.0 - STU2
Da Vinci Risk Adjustment Implementation Guide
2.0.0 - STU2
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
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 Data Submission Client Capability Statement |
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. |
| Risk Adjustment Data Submission Server Capability Statement |
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. |
| 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 the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources.
| measurereport-category |
Search based on the measurereport-category extension |
These define constraints on FHIR resources for systems conforming to this implementation guide.
| Patient Group |
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. |
| RA Parameters ccRemark Patch Profile |
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. |
| Risk Adjustment Coding Gap MeasureReport |
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. |
| 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 Data Exchange MeasureReport |
This profile is based on the MeasureReport. It is used for Provider to submit data such as clinical evaluation evidence to Payer. |
| Risk Adjustment Model Measure |
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. |
These define constraints on FHIR data types for systems conforming to this implementation guide.
| Condition Category Remark |
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. |
| Confidence Scale |
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. |
| Diagnosis Code |
Diganosis code(s) of the condition, such as ICD-10 codes. |
| Evidence Status |
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. |
| Group Reference |
This extension identifies which Condition Category (CC) the supporting evidence (represented by |
| Hierarchical Status |
Indicates how hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded. |
| Payer Coding Gap Report Id |
Unique id of the original payer generated coding gap report. This is the MeasureReport.id from the Risk Adjustment Coding Gap Report profile. |
| Reporting Vendor Extension |
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. |
| Risk Adjustment Clinical Data Collection Deadline |
Indicates the deadline for collecting data to close Condition Category (CC) coding gaps for a risk adjustment model of a measurement period. |
| Risk Adjustment Condition Category Type |
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. |
| Risk Adjustment Evidence Status Date |
Risk adjustment evidence status date |
These define sets of codes used by systems conforming to this implementation guide.
| Coding Gap Remark |
Coded remark for a coding gap |
| Confidence Scale Value Set |
Codes that describe the confidence scale of a risk adjustment Condition Category (CC). |
| Remark Reason |
Reason for the remark |
| Risk Adjustment Condition Category Type ValueSet |
Codes that indicate whether the Condition Category (CC) gap is historic, suspected, or net-new. |
| Risk Adjustment Evidence Status ValueSet |
Codes that indicate whether a coding gap is an open-gap, invalid-gap, closed-gap, or pending. |
| Risk Adjustment Hierarchical Status ValueSet |
Codes that indicate how hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded. |
| 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. |
These define new code systems used by systems conforming to this implementation guide.
| Coding Gap Remark CodeSystem |
Coded remark for coding gap |
| Remark Reason CodeSystem |
Reason codes for remark |
| Risk Adjustment Condition Category Type CodeSystem |
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. |
| Risk Adjustment Evidence Status CodeSystem |
Code system that indicates whether a coding gap is an open-gap, invalid-gap, closed-gap, or pending. |
| Risk Adjustment Hierarchical Status CodeSystem |
Code system that indicates how hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded. |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
IG © 2021+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.davinci-ra#2.0.0 based on FHIR 4.0.1. Generated 2024-12-10
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