Page History

Short Description

Test the Da Vinci Risk Adjustment Implementation Guide  

Long Description

Test the profiles and operations specified in the Da Vinci Risk Adjustment IG STU 2 that was in the January 2023 Ballot

• Test operations: $davinci-ra.report, $davinci-ra.remediate, $davinci-ra.resolve, $davinci-ra.evaluate-measure
• Test the profiles including Risk Adjustment Coding Gap Bundle, Risk Adjustment Coding Gap Composition, Risk Adjustment Coding Gap Clinical Evaluation DetectedIssue, and Risk Adjustment Coding Gap Original DetectedIssue
• Test the end-to-end scenario of payer sends risk adjustment coding gap reports and providers/certified coders send the updated risk adjustment coding gap reports back to the payer with supporting evidence 

Type

Test an Implementation Guide

Related Tracks?

Call for participants

Payers, providers, vendors

Track Prerequisites

Read the IG specifications

• CI Build: https://build.fhir.org/ig/HL7/davinci-ra/

Create an account with Touchstone for testing using Touchstone test scripts 

• See Build and Validate with Touchstone on Da Vinci Implementation Support confluence page for tutorials, registration, and documentations

Track Lead(s)

Yan Heras

Track Lead Email(s)

yan.heras@optimumehealth.com

Specification Information

https://build.fhir.org/ig/HL7/davinci-ra/

Zulip stream

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

Track Kick off Call

Kick off call will be held at the Da Vinci Risk Adjustment weekly call: 3pm - 4pm ET, Thursday, December 15th, 2022 

System Roles

Testing Scenario:

Testing Scenarios are under construction

System roles

• Payer   
• Provider

• Risk Adjustment Coder (Note that Risk Adjustment Coder could be either internal or 3rd party vendor

• contracted with Payer)

Coding Gap Generation Scenario

• Action:
  • Payer calls $ra.coding-gap operation to

• • create a Risk Adjustment Coding Gap Bundle

• • for a group of patients (use a group of one patient for this testing scenario to demonstrate group)
• Preconditions:
  • Payer Server is pre-populated with Risk Adjustment Coding Gap MeasureReport and resources for supporting evidence
• Success Criteria:

• • returns

New RA Coding Gap Bundle
  Composition (status: preliminary)
    Original DetectedIssue (status: final)

    Original Evidence
  RA MeasureReport

• Bonus Point: 

Coding Gap Remediation Scenario 1 - (Provider request gap closure and invalidation)

• Actions:
  • Provider calls $ra.remediate-coding-gap

• • operation to create a new Risk Adjustment Coding Gap Bundle
• Preconditions:
  • Original Risk Adjustment Coding Gap Bundle is available on the Provider Server
  • Clinical Evaluation DetectedIssue and clinical evaluation evidence are available on the Provider Server
• Success Criteria: 
  • returns 

New RA Coding Gap Bundle
  Existing Composition (status: preliminary)
    Existing Original DetectedIsssue (status: final)
    Existing Original Evidence
    Existing RA MeasureReport

Add
    Clinical Evaluation DetectedIssue (status: preliminary)  - for gap closure request
    Clinical Evaluation Evidence

    Clinical Evaluation DetectedIssue (status: preliminary) - for gap invalidation request
    Clinical Evaluation Evidence

Coding Gap Remediation Scenario 2 - Risk Adjustment Coder

• Actions:
  • Risk Adjustment Coder calls $ra.remediate-coding-gap operation to create a new Risk Adjustment Coding Gap Bundle
• Preconditions:
• Success Criteria: 

Coding Gap Remediation Scenario

3  

• Actions:
  • Provider or Risk Adjustment Coder calls $ra.approve-coding-gap operation
• Preconditions:
• Success Criteria: 

Coding Gap Resolution Scenario

• • Actions:
    • Provider or Risk Adjustment Coder calls $ra.remediate-resolve-gap operation
  • Preconditions:
  • Success Criteria: 

Test Scenarios:

https://docs.google.com/spreadsheets/d/1vcVp1KJH4_aERiwy7x-lARmYXR1JlcbniggPyQ6ZgGg/edit#gid=0

— — —

Reference Implementation End Points: 

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/ 

Novillus End Points:

• Payer End Point: 
• Provider End Point: 
• Risk Adjustment Coder End Point: 

There are two separate instances of Risk Adjustment validator set up in Touchstone. One points to the STU1 IG and another points to the CI Build which contains the STU2 content in development. 

Test Scripts: https://touchstone.aegis.net/touchstone/testdefinitions

• • • All test scripts are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA
    • The test cases for Parameters are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA/01-RAReport/04-RA-ReportParameters
    • The test cases for results are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA/01-RAReport/05-RA-ReportResults

Connectathon Manager: http://conman.clinfhir.com/?event=con31

Document Testing Results in the Connectathon Manager

Security and Privacy Considerations: