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
| Page standards status: Trial-use | Maturity Level: 1 |
<OperationDefinition xmlns="http://hl7.org/fhir">
<id value="risk-gap"/>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: OperationDefinition risk-gap</b></p><a name="risk-gap"> </a><a name="hcrisk-gap"> </a><p>URL: [base]/MeasureReport/$risk-gap</p><p>URL: [base]/MeasureReport/[id]/$risk-gap</p><h3>Parameters</h3><table class="grid"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>periodStart</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td/><td><div><p>The start of a clinical evaluation period.</p>
</div></td></tr><tr><td>IN</td><td>periodEnd</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td/><td><div><p>The end of a clinical evaluation period.</p>
</div></td></tr><tr><td>IN</td><td>subject</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/references.html#Reference">Reference</a> (<a href="http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-patient.html" title="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0">US Core Patient Profile</a>)</td><td/><td><div><p>A reference to Patient resource as input parameter, which provides data such as patient's first name, last name, date of birth.</p>
</div></td></tr><tr><td>IN</td><td>coverage</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/references.html#Reference">Reference</a> (<a href="http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-coverage.html" title="http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0">US Core Coverage Profile</a>)</td><td/><td><div><p>A reference to Coverage resource, which provides information such as the subscriberId.</p>
</div></td></tr><tr><td>IN</td><td>organization</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/references.html#Reference">Reference</a> (<a href="http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-organization.html" title="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0">US Core Organization Profile</a>)</td><td/><td><div><p>A reference to Organization resource, which provides information for provider organization</p>
</div></td></tr><tr><td>IN</td><td>practitionerRole</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/references.html#Reference">Reference</a> (<a href="http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-practitionerrole.html" title="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|7.0.0">US Core PractitionerRole Profile</a>)</td><td/><td><div><p>A reference to Pracitioner Role resource, which provides information about the provider, such as provider taxonomy, provider NPI</p>
</div></td></tr><tr><td>IN</td><td>encounter</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/references.html#Reference">Reference</a> (<a href="http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-encounter.html" title="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter|7.0.0">US Core Encounter Profile</a>)</td><td/><td><div><p>A reference to Encounter resource, which provides information such as the encounter id and date of service.</p>
</div></td></tr><tr><td>IN</td><td>ccType</td><td/><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#code">code</a></td><td><a href="ValueSet-cc-type.html">Condition Category Type</a> (Extensible)</td><td><div><p>This Condition Category (CC) gaps will be filterd based on the CC type code, whether it is suspected, historic, and/or net-new.</p>
</div></td></tr><tr><td>IN</td><td>evidenceStatus</td><td/><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#code">code</a></td><td><a href="ValueSet-evidence-status.html">Evidence Status</a> (Extensible)</td><td><div><p>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.</p>
</div></td></tr><tr><td>IN</td><td>data</td><td/><td>1..1</td><td><a href="http://hl7.org/fhir/R4/bundle.html">Bundle</a></td><td/><td><div><p>Referenced resources by parameters of this operation provided as a Bundle.</p>
</div></td></tr><tr><td>OUT</td><td>return</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/bundle.html">Bundle</a></td><td/><td><div><p>This operation returns a Bundle of MeasureReports and associated resources.</p>
</div></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="1"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="cqi"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use"/>
</extension>
<url
value="http://hl7.org/fhir/us/davinci-ra/OperationDefinition/risk-gap"/>
<version value="3.0.0-ballot"/>
<name value="RiskGap"/>
<title value="Risk Gap"/>
<status value="active"/>
<kind value="operation"/>
<date value="2026-03-19T18:57:56+00:00"/>
<publisher value="HL7 International / Clinical Quality Information"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/cqi"/>
</telecom>
</contact>
<description
value="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."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
<display value="United States of America"/>
</coding>
</jurisdiction>
<code value="risk-gap"/>
<resource value="MeasureReport"/>
<system value="false"/>
<type value="true"/>
<instance value="true"/>
<parameter>
<name value="periodStart"/>
<use value="in"/>
<min value="1"/>
<max value="1"/>
<documentation value="The start of a clinical evaluation period."/>
<type value="date"/>
</parameter>
<parameter>
<name value="periodEnd"/>
<use value="in"/>
<min value="1"/>
<max value="1"/>
<documentation value="The end of a clinical evaluation period."/>
<type value="date"/>
</parameter>
<parameter>
<name value="subject"/>
<use value="in"/>
<min value="1"/>
<max value="1"/>
<documentation
value="A reference to Patient resource as input parameter, which provides data such as patient's first name, last name, date of birth."/>
<type value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0"/>
</parameter>
<parameter>
<name value="coverage"/>
<use value="in"/>
<min value="1"/>
<max value="1"/>
<documentation
value="A reference to Coverage resource, which provides information such as the subscriberId."/>
<type value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0"/>
</parameter>
<parameter>
<name value="organization"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<documentation
value="A reference to Organization resource, which provides information for provider organization"/>
<type value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0"/>
</parameter>
<parameter>
<name value="practitionerRole"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<documentation
value="A reference to Pracitioner Role resource, which provides information about the provider, such as provider taxonomy, provider NPI"/>
<type value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|7.0.0"/>
</parameter>
<parameter>
<name value="encounter"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<documentation
value="A reference to Encounter resource, which provides information such as the encounter id and date of service."/>
<type value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter|7.0.0"/>
</parameter>
<parameter>
<name value="ccType"/>
<use value="in"/>
<min value="0"/>
<max value="*"/>
<documentation
value="This Condition Category (CC) gaps will be filterd based on the CC type code, whether it is suspected, historic, and/or net-new."/>
<type value="code"/>
<binding>
<strength value="extensible"/>
<valueSet value="http://hl7.org/fhir/us/davinci-ra/ValueSet/cc-type"/>
</binding>
</parameter>
<parameter>
<name value="evidenceStatus"/>
<use value="in"/>
<min value="0"/>
<max value="*"/>
<documentation
value="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."/>
<type value="code"/>
<binding>
<strength value="extensible"/>
<valueSet
value="http://hl7.org/fhir/us/davinci-ra/ValueSet/evidence-status"/>
</binding>
</parameter>
<parameter>
<name value="data"/>
<use value="in"/>
<min value="1"/>
<max value="1"/>
<documentation
value="Referenced resources by parameters of this operation provided as a Bundle."/>
<type value="Bundle"/>
</parameter>
<parameter>
<name value="return"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<documentation
value="This operation returns a Bundle of MeasureReports and associated resources."/>
<type value="Bundle"/>
</parameter>
</OperationDefinition>
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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