Da Vinci Risk Adjustment Implementation Guide
2.1.0 - STU 2.1 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 2.1.0 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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Home
... 2 Reading this IG - FHIR Introduction
... 3 Background
... 4 Projects and Participants
... 5 General Guidance
... 6 Report Generation
... 7 Report Query
... 8 Submit Data To Payer
... 9 Add Remark to Condition Category
... 10 Digital Condition Category (dCC)
... 11 Security, Privacy, and Safety
... 12 Glossary
... 13 Profiles
... 14 Extensions
... 15 Search Parameters
... 16 Terminology
... 17 Operation
... 18 Capability Statements
... 19 Examples
... 20 Downloads
... 21 Tooling and Support
... 22 Change Log
... 23 Artifacts Summary
.... 23.1 Risk Adjustment Data Submission Client Capability Statement
.... 23.2 Risk Adjustment Data Submission Server Capability Statement
.... 23.3 Risk Adjustment Reporting Client Capability Statement
.... 23.4 Risk Adjustment Reporting Server Capability Statement
.... 23.5 Evaluate Measure
.... 23.6 Risk Gap
.... 23.7 Submit Remark Data
.... 23.8 MeasureReportCategory
.... 23.9 Patient Group
.... 23.10 RA Parameters ccRemark Patch Profile
.... 23.11 Risk Adjustment Coding Gap MeasureReport
.... 23.12 Risk Adjustment Coding Gap MeasureReport with Remark
.... 23.13 Risk Adjustment Coding Gap Report Bundle
.... 23.14 Risk Adjustment Data Exchange MeasureReport
.... 23.15 Risk Adjustment MeasureReport With Remark Bundle
.... 23.16 Risk Adjustment Model Measure
.... 23.17 Clinical Data Collection Deadline Extension
.... 23.18 Condition Category Remark Extension
.... 23.19 Condition Category Type Extension
.... 23.20 Confidence Scale Extension
.... 23.21 Diagnosis Code Extension
.... 23.22 Evidence Status Date Extension
.... 23.23 Evidence Status Extension
.... 23.24 Group Reference Extension
.... 23.25 Hierarchical Status Extension
.... 23.26 Payer Coding Gap Report Id Extension
.... 23.27 Reporting Vendor Extension
.... 23.28 Coding Gap Remark
.... 23.29 Condition Category Type
.... 23.30 Evidence Status
.... 23.31 Hierarchical Status
.... 23.32 RA Confidence Scale
.... 23.33 Remark Reason
.... 23.34 Sample CMS Hierarchical Condition Category
.... 23.35 Coding Gap Remark Codes
.... 23.36 Remark Reason Codes
.... 23.37 Risk Adjustment Condition Category Type Codes
.... 23.38 Risk Adjustment Evidence Status Codes
.... 23.39 Risk Adjustment Hierarchical Status Codes
.... 23.40 Condition01Pat03: Other artificial openings of gastrointestinal tract status
.... 23.41 Condition02Pat02: Diabetes mellitus due to underlying condition with other diabetic kidney complication
.... 23.42 Condition03Pat01: Chronic obstructive pulmonary disease with (acute) exacerbation
.... 23.43 Condition04Pat03: Chronic obstructive pulmonary disease with (acute) exacerbation
.... 23.44 Condition05Pat03: Unspecified protein-calorie malnutrition
.... 23.45 Condition06Pat03: Crohn’s disease of large intestine with unspecified complications
.... 23.46 Condition07Pat03: Other persistent atrial fibrillation
.... 23.47 Condition08Pat01: Bipolar disorder, current episode mixed, mild
.... 23.48 Condition09Pat01: Allergic bronchopulmonary aspergillosis
.... 23.49 Condition10Pat01: Long term (current) use of insulin
.... 23.50 Condition11Pat01: Acute pulmonary edema
.... 23.51 Condition12Pat01: Manic episode, unspecified
.... 23.52 Condition15Pat03: Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
.... 23.53 Condition16Pat03: Dependence on renal dialysis
.... 23.54 Condition17Pat01: Body mass index (BMI) 45.0-49.9, adult
.... 23.55 Condition18Pat01: Longstanding persistent atrial fibrillation
.... 23.56 Condition21Pat03: Type 2 diabetes mellitus without complications
.... 23.57 Condition22Pat03: Other acute kidney failure
.... 23.58 Condition23Pat03: Chronic kidney disease, stage 5
.... 23.59 Condition31Pat02: Typical atrial flutter
.... 23.60 Condition32Pat03: Chronic pulmonary embolism
.... 23.61 Condition33Pat01: Respiratory arrest
.... 23.62 Condition35Pat03: Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
.... 23.63 Condition42Pat03: Other artificial openings of gastrointestinal tract status
.... 23.64 Condition43Pat01: Diabetes mellitus due to underlying condition with other diabetic kidney
.... 23.65 Condition44Pat01: Allergic bronchopulmonary aspergillosis
.... 23.66 ConditionR01Pat01: Cystic fibrosis with other intestinal manifestations
.... 23.67 Data Exchange MeasureReport Example01
.... 23.68 Encounter with Dr Hippocrates on 2017-01-18 for Patient 01
.... 23.69 Encounter with Dr Hippocrates on 2017-02-03 for Patient 03
.... 23.70 Encounter with Dr Hippocrates on 2018-07-21 for Patient 01
.... 23.71 Encounter with Dr Hippocrates on 2019-02-10 for Patient 01
.... 23.72 Encounter with Dr Hippocrates on 2020-11-02 for Patient 03
.... 23.73 Encounter with Dr Hippocrates on 2021-01-31 for Patient 03
.... 23.74 Encounter with Dr Hippocrates on 2021-03-27 for Patient 03
.... 23.75 Encounter with Dr Hippocrates on 2021-09-26 for Patient 03
.... 23.76 Encounter with Dr Hippocrates on 2021-10-15 for Patient 01
.... 23.77 Encounter with Dr Osler on 2019-02-07 for Patient 03
.... 23.78 Encounter with Dr Osler on 2019-08-23 for Patient 03
.... 23.79 Encounter with Dr Osler on 2020-02-10 for Patient 03
.... 23.80 Encounter with Dr Osler on 2020-03-03 for Patient 03
.... 23.81 Encounter with Dr Osler on 2020-09-17 for Patient 03
.... 23.82 Encounter with Dr Osler on 2020-12-18 for Patient 03
.... 23.83 Encounter with Dr Osler on 2021-01-30 for Patient 03
.... 23.84 Encounter with Dr Osler on 2021-02-12 for Patient 03
.... 23.85 Encounter with Dr Osler on 2021-07-01 for Patient 03
.... 23.86 Encounter with Dr Osler on 2021-07-14 for Patient 03
.... 23.87 Encounter with Dr Osler on 2021-07-27 for Patient 03
.... 23.88 Encounter with Dr Osler on 2021-08-08 for Patient 03
.... 23.89 Encounter with Dr Pump on 2021-08-06 for Patient 02
.... 23.90 Organization Example: XYZ Laboratory
.... 23.91 Organization: ABC Payer
.... 23.92 Organization: Best RA Vendor
.... 23.93 Organization: Community HealthCenter
.... 23.94 Organization: Community Urgent Care
.... 23.95 Organization: GHH Outpatient Clinic
.... 23.96 Organization: Risk Adjustment Author
.... 23.97 Outpatient Note for Patient01 Eve Everywoman
.... 23.98 Patch Example01 with multiple value (ra-measurereport01)
.... 23.99 Patch Example02 (ra-measurereport01)
.... 23.100 Patient Group Example 1
.... 23.101 Patient Group Example 2
.... 23.102 Patient01: Eve Everywoman
.... 23.103 Patient02: Adam Everyman
.... 23.104 Patient03: Nelda Nuclear
.... 23.105 PHQ9 Total Score for Patient 03
.... 23.106 Practitioner01: Harold Hippocrates
.... 23.107 Practitioner02: Patrick Pump
.... 23.108 Practitioner03: Otto Osler
.... 23.109 RA Coding Gap MeasureReport Example01 with RA Model CMS-HCC V24 for Patient01 Eve Everywoman
.... 23.110 RA Coding Gap MeasureReport Example02 with RA Model CMS-RxHCC V5 for Patient01 Eve Everywoman
.... 23.111 RA Coding Gap MeasureReport Example03 with RA Model CMS-HCC V24 for Patient02 Adam Everyman
.... 23.112 RA Coding Gap MeasureReport Example04 with RA Model CMS-HCC V21 for Patient03 Nelda Nuclear
.... 23.113 RA Coding Gap MeasureReport Example05 with RA Model CMS-RxHCC V5 for Patient03 Nelda Nuclear
.... 23.114 RA Coding Gap MeasureReport Example06 with RA Model CMS-RxHCC V5 for Patient02 Adam Everyman
.... 23.115 RA MeasureReport with Remark Example (ra-measurereport01-with-remark)
.... 23.116 RA Model Example01 CMS-HCC version 24
.... 23.117 RA Model Example02 CMS-HCC version 21
.... 23.118 RA Model Example03 CMS-RxHCC version 5
.... 23.119 Risk Adjustment MeasureReport Bundle example, MeasureReport01: Patient01
.... 23.120 Serum Creatinine for Patient 03
.... 23.121 Submit Data example for sending a C-CDA document
.... 23.122 Trypsin [Mass/volume] in Serum or Plasma for Patient 01
.... 23.123 Trypsin [Mass/volume] in Serum or Plasma for Patient 02