Da Vinci Risk Adjustment Implementation Guide
2.0.0-preview - 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-preview 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

Add Remark to Condition Category

Systems may choose to display the Risk Adjustment Coding Gap Report to a Provider at the time of a patient’s care. When this happens, a Provider (using the Reporting Client role) may choose to add a remark to the report letting the Payer know they took some actions in regard to the coding gap(s) when they saw the patient.

Note: The Condition Category Remark extension is not intended to change the status of a Condition Category gap. To change the status, follow the Submit Data to Payer section of this guidance. Note that both a Condition Category remark and Submit Data to Payer can be generated at the time the Provider sees the patient if that is appropriate.

Figure 2.5-1 Add Remark to Condition Category Overview
report-cc-remark-overview.png

The Condition Category Remark Extension

For adding a remark, there is an extension, called Condition Category Remark. This extension is added to the Risk Adjustment Coding Gap Report within the MeasureReport.group element. This allows for a remark to specifically reference a Condition Category code. Also note the remark is a Complex extension and can repeat. Within the Condition Category Remark extension are several fields, all of which are optional:

  • author indicates who provided the remark. It can link to a US Core Organization, a US Core Practitioner or a US Core PractitionerRole which allows you to reference both a Practitioner and an Organization
  • authorDatetime when the remark was made
  • text a free text remark
  • code a coded remark to indicate the specific action taken. The code list which is extensible includes acknowledged, assessed and not present, assessed and present, and deferred
  • relatedData that could be either an identifier to a reference to a Resource
    • the relatedDataIentifier can be used to link to a claim or document that the provider is sending via another method or transaction

The Provider’s system SHALL NOT change any other part of the original Risk Adjustment Coding Gap Report and can only add the Condition Category Remark to the appropriate MeasureReport.group(s). If a provider wants to share data with the Payer in order to change a gap status, they should use the Submit Data to Payer process.

Once a Condition Category Remark is added to a Risk Adjustment Coding Gap Report, it can be posted to the Payer’s Reporting Server.

Figure 2.5-2 Report Condition Category Remark Workflow
report-cc-remark-workflow.png

Provider Handling of the Condition Category Remark

The Provider may choose to send the Condition Category remark only to the Payer using a light weight approach rather than sending the entire MeasureReport resource. They can use PATCH operation.

Payer Handling of the Condition Category Remark

This implementation guide does not direct any action be taken by the Payer upon receipt of a Risk Adjustment Coding Gap Report with added Condition Category remark(s).

After a Payer generates a subsequent Risk Adjustment Coding Gap Report, in their role as Reporting Server they can choose to include the Condition Category remarks as they see fit. This might include adding the remarks only if received from the same Provider and can include any remarks all the way up to including all Condition Category remarks received from any provider. The Payer is not required to include any Condition Category remarks on subsequently generated Risk Adjustment Coding Gap Report.

Usage

Sending the full MeasureReport with added Remarks to Payer

PUT [base]/MeasureReport/[id]

Examples

Scenario:

A Provider receives a Risk Adjustment Gaps Report from a Payer. After seeing the patient, Remarks are added to the full report and it is updated at the Payer.

PUT Risk Adjustment Coding Gaps Report with Remarks

PUT [base]/MeasureReport/ra-measurereport01

Request body

{
    "resourceType": "MeasureReport",
    "id": "ra-measurereport01",
    "meta": {
        "profile": [
            "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"
        ]
    },
    "extension": [
        {
            "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline",
            "valueDate": "2022-03-31"
        }
    ],
    "status": "complete",
    "type": "individual",
    "measure": "https://build.fhir.org/ig/HL7/davinci-ra/Measure-RAModelExample01",
    "subject": {
        "reference": "Patient/ra-patient01"
    },
    "date": "2021-10-18",
    "reporter": {
        "reference": "Organization/ra-payer01"
    },
    "period": {
        "start": "2021-01-01",
        "end": "2021-09-30"
    },
    "group": [
        {
            "id": "group-001",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "18",
                        "display": "Diabetes with Chronic Complications"
                    }
                ],
                "text": "HCC 18: Diabetes with Chronic Complications"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "historic",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "closed-gap",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-04-01"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "id": "group-002",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "111",
                        "display": "Chronic Obstructive Pulmonary Disease"
                    }
                ],
                "text": "HCC 111: Chronic Obstructive Pulmonary Disease"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "historic",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "pending",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-09-29"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "id": "group-003",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "59",
                        "display": "Major Depressive, Bipolar, and Paranoid Disorders"
                    }
                ],
                "text": "HCC 59: Major Depressive, Bipolar, and Paranoid Disorders"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "historic",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "open-gap",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2020-07-15"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark",
                    "extension": [
                        {"url": "author",
                        "valueIdentifier": {
                            "system": "http://hl7.org/fhir/sid/us-npi",
                            "value": "1234567890"
                            }
                        },
                        {"url": "authorDatetime",
                        "valueDateTime": "2021-11-01"
                        },
                        {"url": "text",
                        "valueString": "Diagnosis added"
                        },
                        {"url": "code",
                            "valueCodeableConcept" : {
                                "coding": [
                                    {
                                    "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/coding-gap-remark",
                                    "code": "assessed-present",
                                    "display": "Assessed and present"
                                    }
                                ]
                            }
                        },
                        {"url": "relatedDataIdentifier",
                            "valueIdentifier":  {
                                "system": "http://example.org/fhir/myclaimno",
                                "value": "CLM23333"}
                        }
                    ]
                }
            ]
        },
        {
            "id": "group-004",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "112",
                        "display": "Fibrosis of lung and other chronic lung disorders"
                    }
                ],
                "text": "HCC 112: Fibrosis of lung and other chronic lung disorders"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "historic",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "closed-gap",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-04-27"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "id": "group-005",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "19",
                        "display": "Diabetes without Complications"
                    }
                ],
                "text": "HCC 19: Diabetes without Complications"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "historic",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "pending",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-09-27"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "id": "group-006",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "84",
                        "display": "Cardio-Respiratory Failure and Shock"
                    }
                ],
                "text": "HCC 84: Cardio-Respiratory Failure and Shock"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "historic",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "open-gap",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2020-12-15"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark",
                    "extension": [
                        {"url": "author",
                            "valueIdentifier": {
                            "system": "http://hl7.org/fhir/sid/us-npi",
                            "value": "1234567890"
                            }
                        },
                        {"url": "authorDatetime",
                        "valueDateTime": "2021-11-01"
                        },
                        {"url": "text",
                        "valueString": "Continue evaluation"
                        },
                        {"url": "code",
                            "valueCodeableConcept" : {
                                "coding": [
                                    {
                                    "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/coding-gap-remark",
                                    "code": "deferred",
                                    "display": "Deferred"
                                    }
                                ]
                            }
                        }
                    ]
                }
            ]

        },
        {
            "id": "group-007",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "22",
                        "display": "Morbid Obesity"
                    }
                ],
                "text": "HCC 22: Morbid Obesity"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "suspected",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "closed-gap",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-03-15"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "id": "group-008",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "96",
                        "display": "Specified Heart Arrhythmias"
                    }
                ],
                "text": "HCC 96: Specified Heart Arrhythmias"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "suspected",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "pending",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-09-27"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "id": "group-009",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "110",
                        "display": "Cystic Fibrosis"
                    }
                ],
                "text": "HCC 110: Cystic Fibrosis"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "suspected",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "open-gap",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2020-07-15"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "255508009",
                                "system": "http://snomed.info/sct",
                                "display": "Medium"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark",
                    "extension": [
                        {"url": "author",
                        "valueIdentifier": {
                            "system": "http://hl7.org/fhir/sid/us-npi",
                            "value": "1234567890"
                            }
                        },
                        {"url": "authorDatetime",
                        "valueDateTime": "2021-11-01"
                        },
                        {"url": "text",
                        "valueString": "Not diagnosed"
                        },
                        {"url": "code",
                            "valueCodeableConcept" : {
                                "coding": [
                                    {
                                    "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/coding-gap-remark",
                                    "code": "assessed-not-present"
                                    
                                    }
                                ]
                            }
                        },
                        {"url": "relatedDataIdentifier",
                            "valueIdentifier":  {
                                "system": "http://example.org/fhir/mychart",
                                "value": "432203939"}
                        }
                    ]
                }
            ]
        },
        {
            "id": "group-010",
            "code": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/cmshcc",
                        "version": "24",
                        "code": "83",
                        "display": "Respiratory Arrest"
                    }
                ],
                "text": "HCC 83: Respiratory Arrest"
            },
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "net-new",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "pending",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"
                            }
                        ]
                    }
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
                    "valueDate": "2021-09-28"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "code": "applied-not-superseded",
                                "system": "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"
                            }
                        ]
                    }
                }
            ]
        }
    ],
    "evaluatedResource": [
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-001"
                }
            ],
            "reference": "Condition/ra-condition02pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-002"
                }
            ],
            "reference": "Condition/ra-condition03pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-003"
                }
            ],
            "reference": "Condition/ra-condition08pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-004"
                }
            ],
            "reference": "Condition/ra-condition09pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-005"
                }
            ],
            "reference": "Condition/ra-condition10pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-006"
                }
            ],
            "reference": "Condition/ra-condition11pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-007"
                }
            ],
            "reference": "Condition/ra-condition17pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-008"
                }
            ],
            "reference": "Condition/ra-condition18pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-010"
                }
            ],
            "reference": "Condition/ra-condition33pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-001"
                }
            ],
            "reference": "Condition/ra-condition43pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-004"
                }
            ],
            "reference": "Condition/ra-condition44pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-001"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-007"
                }
            ],
            "reference": "Encounter/ra-encounter02pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-002"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-005"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-008"
                },
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-010"
                }
            ],
            "reference": "Encounter/ra-encounter03pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-003"
                }
            ],
            "reference": "Encounter/ra-encounter08pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-004"
                }
            ],
            "reference": "Encounter/ra-encounter09pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-006"
                }
            ],
            "reference": "Encounter/ra-encounter11pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-001"
                }
            ],
            "reference": "Encounter/ra-encounter43pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-004"
                }
            ],
            "reference": "Encounter/ra-encounter44pat01"
        },
        {
            "extension": [
                {
                    "url": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
                    "valueString": "group-009"
                }
            ],
            "reference": "Observation/ra-obs21pat01"
        }
    ]
}

Response

HTTP/1.1 200 ok

Using Patch to update the Payer’s MeasureReport with Remarks

PATCH [base]/MeasureReport/[id]

Examples

Scenario:

A Provider receives a Risk Adjustment Gaps Report from a Payer. The Provider uses PATCH to update the Report at the Payer with just the Remark information they add at time of visit.

PATCH Risk Adjustment Coding Gaps Report with Remarks

PATCH [base]/MeasureReport/ra-measurereport01

Request body

{
    "resourceType": "Parameters",
    "id": "ra-measurereport01",
    "parameter": [
        {
            "name": "operation",
            "part": [
                {
                    "name": "type",
                    "valueCode": "add"
                },
                {
                    "name": "path",
                    "valueString": "MeasureReport.group.where(id='group-001')"
                },
                {
                    "name": "name",
                    "valueString": "extension"
                },
                {
                    "name": "value",
                    "part": [
                        {
                            "name": "url",
                            "valueUri": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark"
                        },
                        {
                            "name": "extension",
                            "part": [
                                {
                                    "name": "url",
                                    "valueUri": "authorDatetime"
                                },
                                {
                                    "name": "value",
                                    "valueDateTime": "2023-12-11"
                                }
                            ]
                        }
                    ]
                }
            ]
        },
        {
            "name": "operation",
            "part": [
                {
                    "name": "type",
                    "valueCode": "add"
                },
                {
                    "name": "path",
                    "valueString": "MeasureReport.group.where(id='group-001')"
                },
                {
                    "name": "name",
                    "valueString": "extension"
                },
                {
                    "name": "value",
                    "part": [
                        {
                            "name": "url",
                            "valueUri": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark"
                        },
                        {
                            "name": "extension",
                            "part": [
                                {
                                    "name": "url",
                                    "valueUri": "text"
                                },
                                {
                                    "name": "value",
                                    "valueString": "Example author text for a condition category."
                                }
                            ]
                        }
                    ]
                }
            ]
        },
        {
            "name": "operation",
            "part": [
                {
                    "name": "type",
                    "valueCode": "add"
                },
                {
                    "name": "path",
                    "valueString": "MeasureReport.group.where(id='group-002')"
                },
                {
                    "name": "name",
                    "valueString": "extension"
                },
                {
                    "name": "value",
                    "part": [
                        {
                            "name": "url",
                            "valueUri": "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark"
                        },
                        {
                            "name": "extension",
                            "part": [
                                {
                                    "name": "url",
                                    "valueUri": "authorDatetime"
                                },
                                {
                                    "name": "value",
                                    "valueDateTime": "2024-01-07"
                                }
                            ]
                        }
                    ]
                }
            ]
        }
    ]
}

Response

HTTP/1.1 200 ok