Insurance denials are a growing cause of concern for hospitals and care providers. Denial write-offs and subsequent administrative costs involved in reworking them, pile up to destabilize the financial operations of a care provider. Your effort to reduce the frequency of insurance denials should comprise of a comprehensive evaluation of the common reasons that cause them and technological solutions that can help eliminate them. Download the whitepaper to understand how you can evaluate the areas of your reimbursement process, to reduce the frequency of denied claims.

1. Clinical Quality Language
A new feature for quality measure
Healthcare Consultant Keerthi Chavva is a subject matter expert at Nalashaa with
hands-on experience with different clinical and billing workflows. She is proficient
with analyzing and embedding different regulations within regular workflows
and identifying solutions that help providers with better A/R outcomes. She is
passionate about creating generalized solutions that indicate providers from
multiple perspectives w.r.t different regulatory programs.

2. What is Clinical Quality
Language (CQL)?
Why is CQL Important in the
Healthcare Market?
How is CQL Different from
CQM?
Benefits of CQL
Future of CQL in the
Healthcare Market
Advantages of CQL
based CQM over Existing
Implementation of CQM
Technical Approach
to Achieve CQL
Implementation
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Contents

3. All rights reserved © 2019 6
The major endeavor in this whole exercise is the development of the CQL Engine. While this can be implemented in
different ways , we recommend the FHIR route. The CQL Engine understands CQL grammar through lexical analysis
and parsing components in order to identify the respective population criteria based on the measure. This in turn is
split into different FHIR queries to pull information from respective EHR systems, parse and compute participating
patients based on the criteria.
The retrieved data is then converted into CAT 1 files. These files are further consolidated and stratified to generate a
CAT3 file necessary for provider submissions in March.
Now the same solution can be extended to meet CDS requirements by using them to provide alerts to providers.
This enables them to perform better in quality reporting. The diagram below denotes the workings of the CQL engine.
Technical Approach to Achieving CQL
Implementation

4. We listen, we understand and we deliver.
WehavebeenaroundforawhilenowandhavebeenmakingourmarkintheHealthcare
industry. We have been steadily moving into various areas of US Healthcare, starting
off from Meaningful Use Stage 2. With time we have traversed the journey from the
clinical space to financial aspects of healthcare. Kind words from our clients and their
continued belief in our capabilities to deliver have kept us steadfast on the path of
growth.
CQL is precise enough for machines to interpret and separates out
the logical expression of quality measures and CDS criteria from the
domain model.
This improves the pace of specifying, implementing and testing
new quality measures by up to 90%. Nalashaa offers technology
and services to help payers, providers and technology vendors
adopt the benefits of CQL.
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510 Thornall Street, Suite 210, Edison, NJ-08837, USA
732-602-2560 X 200 www.nalashaahealth.com
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