June 25, 2020
Did you know there is only one National Provider Identifier (NPI) Enumerator that services the entire health care provider community across the nation? We met with Darren Kallod, Operations Manager to learn more about the NPI Enumerator project and how his team pulls together amid times of uncertainty.
1. How long have you worked at Cognosante?
I have worked at Cognosante for 15 years. I was on the initial proposal and implementation team when Fox Systems (now Cognosante) won and started the NPI Enumerator project in Fargo in 2005.
2. How would you describe the work of the NPI Enumerator project?
NPI is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. Prior to NPI, health care providers had different identifiers for every health plan. Under the NPI initiative, all covered health care providers and organizations register with the government and are assigned a 10-digit NPI, used to identify themselves on health care claims submitted to any payer. We (Cognosante) serve as the NPI Enumerator, meaning we provide contact center support to providers by answering NPI-related questions.
We also perform NPI application processing r functions, entering initial paper applications as well as any change requests received via mail and closing out online submissions that require additional investigation or work prior to be being processed.
Finally, we collaborate closely with the National Plan and Provider Enumeration System (NPPES) development team and CMS on issues, enhancements, testing, and deployments for new NPPES version releases.
3. How does this work impact CMS/HIPAA compliance?
NPI was mandated under HIPAA and is on the front lines of accommodating CMS’ administrative simplification and fraud, waste and abuse objectives. Becoming enumerated by obtaining an NPI is a required step before enrolling with Medicare, Medicaid and other government or commercial health plans. It’s critical in identifying and registering all health care providers and their services to the beneficiary community.
4. What should our employees know about the NPI Enumerator project?
The NPI Enumerator Project—Cognosante’s first operational project and facility—has been a significant cornerstone to Cognosante’s growth. It has served as a springboard to current Business Process Outsourcing initiatives and has helped us grow and mature our capabilities. There is only one NPI Enumerator that services the entire health care provider community across the nation, providing significant visibility and leverage within the industry and to CMS.
5. Are there any compelling success stories you can share?
Given the current national emergency surrounding COVID-19, and the uncertainty of what each day/week will hold, I am reminded of one of our legacy stories resulting from a local natural disaster in 2009.
Fargo experienced record snowfall that winter and found itself facing severe flooding that spring. It was a tense period of uncertainty for several weeks, threatening to undo our hard work. In a matter of days, and amid assisting our neighbors and city in fighting the flood, we stood up a temporary office and call center about 100 miles west of Fargo and relocated a skeleton crew to that facility.
Despite the emergency unfolding around us, we were able to pull together and continue providing services to health care providers from around the country—thanks to the incredible determination and commitment of our physically and emotionally taxed team.
The city was ultimately spared, our reputation with CMS was sharpened, and our team was strengthened by what we’d been through, together. Experiences like these give us hope and strength to overcome challenges and we can be better for going through it—a reminder that proves as relevant today as it did ten years ago.
6. What’s on the horizon for the NPI Enumerator project from a strategic growth perspective?
Our current 5-year contract is set to expire this year, so we are actively anticipating the re-compete and hope to expand our role on the project for the next several years.
7. What excites you most about the work you do every day?
The successes we’ve experienced, the competence we’ve acquired, and the first-hand interactions we have in serving health care providers from around the country and even internationally is huge. I delight in acting as a catalyst for resolving issues and implementing improvements for our customers and partners. It’s also incredibly rewarding and a true privilege to work with such talented people—helping them expand their networks, exercise their skills and gifts, and go on to do great things in their careers.
With 15 years behind us, the NPI project has benefited from the contributions of so many great people that are now contributors and leaders elsewhere in the company and in the industry. That’s a trend I hope we can continue to foster for years to come.