HL7 FHIR® Implementation Guide: Risk Adjustment, Release 1 - US Realm
The Da Vinci Fast Healthcare Interoperability Resource (FHIR) Risk Adjustment Implementation Guide describes exchanging risk adjustment coding gaps between payers and providers. Risk adjusted premium calculations are important to government managed care. To better inform providers of opportunities to address risk adjusted conditions, better enable payers to communicate risk adjustment information, and enhance government sponsors’ ability to allocate funding accurately, payers and providers need a standard protocol to share and receive clinical data related to risk adjustment and a standard methodology to communicate risk based coding, documentation and submission status of chronic conditions. The STU1 of this implementation guide focuses on the standard exchange format of risk adjustment coding gaps from payers to providers, it offers potential for reducing administrative burden experienced by providers by standardizing the reporting they receive from all payers.
See the specification at http://hl7.org/fhir/us/davinci-ra/STU1
HL7 FHIR® Implementation Guide: Risk Adjustment, Release 1 - US Realm may also go by the following names or acronyms:
- Improve the accuracy and completeness of risk adjustment.
- Facilitates communication of risk adjustment coding gaps and efficient partnerships between payers and providers to align incentives
- Reduces the administrative burden associated with the current processes by creating a standard for sharing risk adjustment information
- Minimizes health information gaps and improves documentation of risk adjusted conditions, leading to more appropriate and equitable financial revenues.
- Da Vinci; Da Vinci risk adjustment Reference Implementation
This implementation guide is supported by the Da Vinci initiative which is a private effort to accelerate the adoption of Health Level Seven International Fast Healthcare Interoperability Resources (HL7® FHIR®) as the standard to support and integrate value-based care (VBC) data exchange across communities. Like all Da Vinci Implementation Guides, it follows the HL7 Da Vinci Guiding Principles for exchange of patient health information. As an HL7 FHIR Implementation Guide, changes to this specification are managed by the sponsoring Clinical Quality Information (CQI) Work Group and are incorporated as part of the standard balloting process.
|See the standard at http://hl7.org/fhir/us/davinci-ra/STU1.|
- Clinical Quality
- Financial Management
RESPONSIBLE WORK GROUP
- Implementation Guide
- Clinical Decision Support Systems Vendors
- EHR, PHR Vendors
- Emergency Services Providers
- Health Care IT Vendors
- Healthcare Institutions
- Quality Reporting Agencies