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 2.1.0 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

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Resource Profile: Risk Adjustment Coding Gap MeasureReport with Remark

This profile represents a risk adjustment coding gap report with condition categories and at least one of the condition category has one or more condition category remark(s).

Usages:

• Use this Profile: Risk Adjustment MeasureReport With Remark Bundle

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MeasureReport		0..*	RiskAdjustmentCodingGapMeasureReport	A risk adjustment coding gap report with ccRemark present.
group		1..*	BackboneElement	A 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.
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MeasureReport	C	0..*	RiskAdjustmentCodingGapMeasureReport	A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x]		1..1	CodeableConcept	Value of extension Binding: MeasureReportCategory (extensible)
coding	Σ	1..1	Coding	Code defined by a terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: ra
extension:clinicalDataCollectionDeadline	S	0..1	date	This 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..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The 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	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile(7.0.0))	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-1
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | 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	SC	1..*	BackboneElement	A 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	S	1..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ccType	S	1..1	CodeableConcept	Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus	S	0..1	CodeableConcept	How 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: Hierarchical Status (extensible)
extension:confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark	SC	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
evaluatedResource	S	0..*	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.
Slices for extension				Content/Rules for all slices
extension:groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MeasureReport.extension:measurereport-category.value[x]	extensible	MeasureReportCategory http://hl7.org/fhir/ValueSet/measurereport-category|5.2.0
MeasureReport.status	required	MeasureReportStatus http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 From the FHIR Standard
MeasureReport.type	required	Fixed Value: individual http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 From the FHIR Standard
MeasureReport.improvementNotation	required	MeasureImprovementNotation http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 From the FHIR Standard
MeasureReport.group.code	example	SampleCMSHCC http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If 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-4	error	MeasureReport	If 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-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MeasureReport	C	0..*	RiskAdjustmentCodingGapMeasureReport	A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x]		1..1	CodeableConcept	Value of extension Binding: MeasureReportCategory (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: ra
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
extension:clinicalDataCollectionDeadline	S	0..1	date	This 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..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Additional identifier for the MeasureReport
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The 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	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile(7.0.0))	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | 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	SC	1..*	BackboneElement	A 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	S	1..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ccType	S	1..1	CodeableConcept	Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus	S	0..1	CodeableConcept	How 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: Hierarchical Status (extensible)
extension:confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark	SC	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
population		0..*	BackboneElement	The populations in the group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..1	CodeableConcept	initial-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..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore	Σ	0..1	Quantity	What score this group achieved
stratifier		0..*	BackboneElement	Stratification results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	What stratifier of the group
stratum		0..*	BackboneElement	Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	CodeableConcept	The stratum value, e.g. male
component		0..*	BackboneElement	Stratifier component values
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	What stratifier component of the group
value		1..1	CodeableConcept	The stratum component value, e.g. male
population		0..*	BackboneElement	Population results in this stratum
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	initial-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..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore		0..1	Quantity	What score this stratum achieved
evaluatedResource	S	0..*	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..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MeasureReport.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
MeasureReport.extension:measurereport-category.value[x]	extensible	MeasureReportCategory http://hl7.org/fhir/ValueSet/measurereport-category|5.2.0
MeasureReport.status	required	MeasureReportStatus http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 From the FHIR Standard
MeasureReport.type	required	Fixed Value: individual http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 From the FHIR Standard
MeasureReport.improvementNotation	required	MeasureImprovementNotation http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 From the FHIR Standard
MeasureReport.group.code	example	SampleCMSHCC http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc From this IG
MeasureReport.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population|4.0.1 From the FHIR Standard
MeasureReport.group.stratifier.stratum.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population|4.0.1 From the FHIR Standard
MeasureReport.evaluatedResource.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If 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-4	error	MeasureReport	If 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-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Summary

Mandatory: 1 element

Maturity: 2

Differential View

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MeasureReport		0..*	RiskAdjustmentCodingGapMeasureReport	A risk adjustment coding gap report with ccRemark present.
group		1..*	BackboneElement	A 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.
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MeasureReport	C	0..*	RiskAdjustmentCodingGapMeasureReport	A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x]		1..1	CodeableConcept	Value of extension Binding: MeasureReportCategory (extensible)
coding	Σ	1..1	Coding	Code defined by a terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: ra
extension:clinicalDataCollectionDeadline	S	0..1	date	This 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..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The 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	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile(7.0.0))	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-1
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | 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	SC	1..*	BackboneElement	A 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	S	1..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ccType	S	1..1	CodeableConcept	Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus	S	0..1	CodeableConcept	How 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: Hierarchical Status (extensible)
extension:confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark	SC	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
evaluatedResource	S	0..*	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.
Slices for extension				Content/Rules for all slices
extension:groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MeasureReport.extension:measurereport-category.value[x]	extensible	MeasureReportCategory http://hl7.org/fhir/ValueSet/measurereport-category|5.2.0
MeasureReport.status	required	MeasureReportStatus http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 From the FHIR Standard
MeasureReport.type	required	Fixed Value: individual http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 From the FHIR Standard
MeasureReport.improvementNotation	required	MeasureImprovementNotation http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 From the FHIR Standard
MeasureReport.group.code	example	SampleCMSHCC http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If 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-4	error	MeasureReport	If 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-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
MeasureReport	C	0..*	RiskAdjustmentCodingGapMeasureReport	A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x]		1..1	CodeableConcept	Value of extension Binding: MeasureReportCategory (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: ra
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
extension:clinicalDataCollectionDeadline	S	0..1	date	This 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..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Additional identifier for the MeasureReport
status	?!SΣ	1..1	code	complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type	SΣC	1..1	code	The 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	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	SΣ	1..1	Reference(US Core Patient Profile(7.0.0))	What individual(s) the report is for
date	SΣ	1..1	dateTime	When the report was generated
reporter	SΣ	1..1	Reference(US Core Organization Profile(7.0.0))	Organization that generated the MeasureReport
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-1
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing
improvementNotation	?!Σ	0..1	CodeableConcept	increase | 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	SC	1..*	BackboneElement	A 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	S	1..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ccType	S	1..1	CodeableConcept	Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus	S	0..1	CodeableConcept	How 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: Hierarchical Status (extensible)
extension:confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark	SC	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
population		0..*	BackboneElement	The populations in the group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..1	CodeableConcept	initial-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..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore	Σ	0..1	Quantity	What score this group achieved
stratifier		0..*	BackboneElement	Stratification results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	What stratifier of the group
stratum		0..*	BackboneElement	Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value		0..1	CodeableConcept	The stratum value, e.g. male
component		0..*	BackboneElement	Stratifier component values
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	What stratifier component of the group
value		1..1	CodeableConcept	The stratum component value, e.g. male
population		0..*	BackboneElement	Population results in this stratum
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	initial-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..1	integer	Size of the population
subjectResults		0..1	Reference(List)	For subject-list reports, the subject results in this population
measureScore		0..1	Quantity	What score this stratum achieved
evaluatedResource	S	0..*	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..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MeasureReport.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
MeasureReport.extension:measurereport-category.value[x]	extensible	MeasureReportCategory http://hl7.org/fhir/ValueSet/measurereport-category|5.2.0
MeasureReport.status	required	MeasureReportStatus http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 From the FHIR Standard
MeasureReport.type	required	Fixed Value: individual http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 From the FHIR Standard
MeasureReport.improvementNotation	required	MeasureImprovementNotation http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 From the FHIR Standard
MeasureReport.group.code	example	SampleCMSHCC http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc From this IG
MeasureReport.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population|4.0.1 From the FHIR Standard
MeasureReport.group.stratifier.stratum.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population|4.0.1 From the FHIR Standard
MeasureReport.evaluatedResource.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If 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-4	error	MeasureReport	If 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-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Summary

Mandatory: 1 element

Maturity: 2

Other representations of profile: CSV, Excel, Schematron