Da Vinci Risk Adjustment Implementation Guide
3.0.0-ballot - STU 3 Ballot
Da Vinci Risk Adjustment Implementation Guide
3.0.0-ballot - STU 3 Ballot
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 3.0.0-ballot 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
| Official URL: http://hl7.org/fhir/us/davinci-ra/OperationDefinition/risk-gap | Version: 3.0.0-ballot | ||||
| Standards status: Trial-use Active as of 2026-03-19 | Maturity Level: 1 | Computable Name: RiskGap | |||
| Other Identifiers: OID:2.16.840.1.113883.4.642.40.29.33.2 | |||||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
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The risk-gap operation is used to request condition Category (CC) gaps for a patient/member and coverage within a specified time period, and for a specific context. The context-id is provided as an HTTP header and not as a parameter of the operation. The Client (i.e., Provider) who calls this operation may also POST references to Organization, PracitionerRole, and/or Encounter resources using the parameters. The data parameter is a Bundle, which could be used to provide the referenced resources. Additionally, this operation also includes parameters to povide ccType and evidenceStatus. The Server (i.e. Payer) uses the resources and/or codes provided using the parameters as filter to get the right risk adjustment coding gap reports to return to the Client.
The contextId header is an optional, non-standard HTTP header used to transmit an internal or system-specific identifier associated with the current request context. For example, a contextId maybe a 'gap-request-id' that is used by some systems to track an appointment that later is morphed into an encounter, and this "gap-request-id" can then be used by the server system to produce a Risk Adjustment Coding Gap Report.
Include the contextId header in FHIR API POST operations. Implementers are expected to document the meaning of contextId used in their implementation and expected format if any constraints apply.
contextId: <string>
<string>: A system-specific identifier, such as an internal request id, gap-request-id, or similar identifier used for internal tracking.
POST [base]/MeasureReport/$risk-gap
Host: example.org
Content-Type: application/fhir+json
contextId: gap-request-id-123
Servers receiving the contextId should log, propagate, or process the header according to their internal policies.
Language: en
URL: [base]/MeasureReport/$risk-gap
URL: [base]/MeasureReport/[id]/$risk-gap
| Use | Name | Scope | Cardinality | Type | Binding | Documentation |
| IN | periodStart | 1..1 | date | The start of a clinical evaluation period. | ||
| IN | periodEnd | 1..1 | date | The end of a clinical evaluation period. | ||
| IN | subject | 1..1 | Reference (US Core Patient Profile) | A reference to Patient resource as input parameter, which provides data such as patient's first name, last name, date of birth. | ||
| IN | coverage | 1..1 | Reference (US Core Coverage Profile) | A reference to Coverage resource, which provides information such as the subscriberId. | ||
| IN | organization | 0..1 | Reference (US Core Organization Profile) | A reference to Organization resource, which provides information for provider organization | ||
| IN | practitionerRole | 0..1 | Reference (US Core PractitionerRole Profile) | A reference to Pracitioner Role resource, which provides information about the provider, such as provider taxonomy, provider NPI | ||
| IN | encounter | 0..1 | Reference (US Core Encounter Profile) | A reference to Encounter resource, which provides information such as the encounter id and date of service. | ||
| IN | ccType | 0..* | code | Condition Category Type (Extensible) | This Condition Category (CC) gaps will be filterd based on the CC type code, whether it is suspected, historic, and/or net-new. | |
| IN | evidenceStatus | 0..* | code | Evidence Status (Extensible) | This Condition Category (CC) gaps will be filterd based on the evidence status, whether the gap is an open-gap, invalid-gap, closed-gap, and/or pending. | |
| IN | data | 1..1 | Bundle | Referenced resources by parameters of this operation provided as a Bundle. | ||
| OUT | return | 0..1 | Bundle | This operation returns a Bundle of MeasureReports and associated resources. |
IG © 2021+ HL7 International / Clinical Quality Information.
Package hl7.fhir.us.davinci-ra#3.0.0-ballot based on FHIR 4.0.1.
Generated
2026-03-19
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