- 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
Milestone | Timeframe |
---|---|
| |
| |
STU2 Ballot | May 2023 |
May2023 Ballot Milestones
Milestone | Ballot Deadlines |
---|---|
Ballot Signup Ends |
|
Ballot Voting Starts |
|
Ballot Voting Ends |
|
Risk Adjustment Team :
Role | Name | Organization | |
Project Co-Lead | Optimum eHealth | yan.heras@optimumehealth.com | |
Project Co-Lead | Stratametrics LLC | vietnguyen@stratametrics.com | |
Project Co-Lead | Providence St. Joseph | john.graham2@providence.org | |
Project Co-Lead | Optum | amy.neftzger@optum.com | |
Project Co-Lead | Centene | brian.murtha@wellcare.com | |
Project Co-Lead | Novillus | ||
Implementation Guide Co-Lead | Optum | linda.michaelsen@optum.com | |
Implementation Guide Co-Lead | Optimum eHealth | ||
Reference Implementation Lead | Smile CDR | rob.reynolds@smilecdr.com | |
Project Management | Teresa Younkin | Point of Care Partners | teresa.younkin@pocp.com |
PMO/Program Manager | Point of Care Partners | jocelyn.keegan@pocp.com |