{
  "description": "The risk-gap operation is used to request condition Category (CC) gaps for a patient/member and coverage within a specified time period, and for a specific context. The context-id is provided as an HTTP header and not as a parameter of the operation. The Client (i.e., Provider) who calls this operation may also POST references to Organization, PracitionerRole, and/or Encounter resources using the parameters. The data parameter is a Bundle, which could be used to provide the referenced resources. Additionally, this operation also includes parameters to povide ccType and evidenceStatus. The Server (i.e. Payer) uses the resources and/or codes provided using the parameters as filter to get the right risk adjustment coding gap reports to return to the Client.",
  "_filename": "OperationDefinition-risk-gap.json",
  "package_name": "hl7.fhir.us.davinci-ra",
  "date": "2026-04-07T00:27:39+10:00",
  "system": false,
  "publisher": "HL7 International / Clinical Quality Information",
  "instance": true,
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "name": "RiskGap",
  "type": "true",
  "experimental": null,
  "resourceType": "OperationDefinition",
  "title": "Risk Gap",
  "package_version": "3.0.0-ballot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 1
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "cqi"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "trial-use"
  } ],
  "status": "active",
  "id": "7df768e5-d51e-4485-8f85-651a79c671aa",
  "resource": [ "MeasureReport" ],
  "kind": "operation",
  "url": "http://hl7.org/fhir/us/davinci-ra/OperationDefinition/risk-gap",
  "code": "risk-gap",
  "version": "3.0.0-ballot",
  "contact": [ {
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/cqi",
      "system": "url"
    } ]
  } ],
  "parameter": [ {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "periodStart",
    "type": "date",
    "documentation": "The start of a clinical evaluation period."
  }, {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "periodEnd",
    "type": "date",
    "documentation": "The end of a clinical evaluation period."
  }, {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "subject",
    "type": "Reference",
    "documentation": "A reference to Patient resource as input parameter, which provides data such as patient's first name, last name, date of birth.",
    "targetProfile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0" ]
  }, {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "coverage",
    "type": "Reference",
    "documentation": "A reference to Coverage resource, which provides information such as the subscriberId.",
    "targetProfile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0" ]
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "organization",
    "type": "Reference",
    "documentation": "A reference to Organization resource, which provides information for provider organization",
    "targetProfile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0" ]
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "practitionerRole",
    "type": "Reference",
    "documentation": "A reference to Pracitioner Role resource, which provides information about the provider, such as provider taxonomy, provider NPI",
    "targetProfile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|7.0.0" ]
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "encounter",
    "type": "Reference",
    "documentation": "A reference to Encounter resource, which provides information such as the encounter id and date of service.",
    "targetProfile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter|7.0.0" ]
  }, {
    "max": "*",
    "min": 0,
    "use": "in",
    "name": "ccType",
    "type": "code",
    "binding": {
      "strength": "extensible",
      "valueSet": "http://hl7.org/fhir/us/davinci-ra/ValueSet/cc-type"
    },
    "documentation": "This Condition Category (CC) gaps will be filterd based on the CC type code, whether it is suspected, historic, and/or net-new."
  }, {
    "max": "*",
    "min": 0,
    "use": "in",
    "name": "evidenceStatus",
    "type": "code",
    "binding": {
      "strength": "extensible",
      "valueSet": "http://hl7.org/fhir/us/davinci-ra/ValueSet/evidence-status"
    },
    "documentation": "This Condition Category (CC) gaps will be filterd based on the evidence status, whether the gap is an open-gap, invalid-gap, closed-gap, and/or pending."
  }, {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "data",
    "type": "Bundle",
    "documentation": "Referenced resources by parameters of this operation provided as a Bundle."
  }, {
    "max": "1",
    "min": 0,
    "use": "out",
    "name": "return",
    "type": "Bundle",
    "documentation": "This operation returns a Bundle of MeasureReports and associated resources."
  } ]
}