Risk Adjustment

Project Scope Statement 

FHIR IG Proposal

• This implementation guide is intended to define exchange methods that support communication of risk based coding gaps among different stakeholders such as payers, providers, and government managed care programs. The focus of this IG is to drive accurate and complete documentation of health conditions for members/patients that would lead to improved quality of care, follow up and outcomes, in addition to more accurate risk-adjusted payment calculations and reduced administrative burdens. ​
• STU1 focused on exchanging risk adjustment coding gap reports from payers to providers.
• STU2 focuses on exchanging risk adjustment coding gap reports from providers back to certified coders and to payers.

Sponsoring Workgroup: Clinical Quality Information (CQI)

RA Implementation Guide:

• Continuous Integration Build: http://build.fhir.org/ig/HL7/davinci-ra/
• STU1 (published 6/16/2022): http://hl7.org/fhir/us/davinci-ra/
• STU2 ballot in the May 2023 ballot cycle

STU Ballot Reconciliation and IG Jira Trackers:

• JIRA Dashboard - Da Vinci Risk Adjustment STU Balloting Dashboard

Reference Implementation:

• Server Endpoint: Reference Implementation using cqf-ruler /HAPI
  

      Payer End Point: https://cloud.alphora.com/sandbox/r4/ra-payer/fhir/ 
      Provider End Point: https://cloud.alphora.com/sandbox/r4/ra-provider/fhir/ 
      Risk Adjustment Coder End Point: https://cloud.alphora.com/sandbox/r4/ra-coder/fhir/ 

Test Scripts: Touchstone Da Vinci RA Test Scripts

Zulip Channel: https://chat.fhir.org/#narrow/stream/311469-Da-Vinci.20Risk.20Adjustment 

Phase One Introduction and Scope

Phase Two Introduction and Scope

Project Milestones

Conference Call Schedule & Dial-Ins

Thursdays at 3pm ET

See: Da Vinci Use Cases#WeeklyMeetingSchedule

May2023 Ballot Milestones

Risk Adjustment Team :