The credential for people who have to defend the claim
Plain rules. Practical controls. Claims you can defend. Enrollment is open for Edition 1.0.
What the CX-PCS credential is
The ClaimetryX Professional Claims Specialist certification is built on the PCS-001 Professional Claims Submission Standard. It teaches the claim from the first eligibility check to the final closed balance, and it holds you to one test throughout: if a decision cannot be defended, it should not be billed.
The programme is 11 sections of study material and knowledge checks, followed by a single scored examination. Nothing is curved and nothing is rounded up.
Why it is worth holding
Claims you can defend
Every rule taught is traced to a primary payer policy or CMS regulation, so a decision you make on the desk can be explained to an auditor.
Standardised method, not trivia
You learn repeatable methods — TRACE, RESOLVE, RECONCILE, CLOSE — that hold up across payers instead of memorising one plan's quirks.
A credential anyone can check
Each certificate carries a unique number that any employer can confirm on the public verification page. It stays valid for two years.
Built for real revenue-cycle teams
Billers, follow-up and denial specialists, appeals writers, coders moving into claims, and the leaders who supervise them.
What you study
- 1
Claim translation and governing authority
What a clean claim is, and who says so.
- 2
Submission, edits and clearinghouse control
Front-end rejections and how to stop them.
- 3
Coverage, eligibility and benefit limits
Confirming payable coverage before the work happens.
- 4
Provider identity and enrolment
Identifiers, taxonomy and place-of-service integrity.
- 5
Coding integrity for claims staff
Where coding and billing responsibilities meet.
- 6
Authorisations and medical necessity
Getting, documenting and defending approvals.
- 7
Denials and appeals
Reading CARC/RARC pairs and writing an appeal that lands.
- 8
Payment posting and reconciliation
Proving the remittance matches the contract.
- 9
Patient responsibility and balance billing
Statements, protections and QMB rules.
- 10
Account lifecycle and closure
Deciding when a balance is finished — and documenting it.
- 11
Practical lab capstone
A rubric-scored end-to-end account you work yourself.
How you are assessed
Examination
50 items · 120 minutes
Passing score
85% (43 correct)
Safety-critical items
19 items — all must be correct
Certificate validity
2 years
Module knowledge checks pass at 80% and practical labs at 80%. Unanswered items are scored as incorrect. A single safety-critical miss on the final examination is a non-pass, whatever the overall score.
How to enroll
- 1
Create your account
Sign up with your work email and set a password. Verification keeps your certificate record tied to you.
- 2
Enroll and start studying
One click enrolls you and opens your learning dashboard with every section, knowledge check and printable desk aid.
- 3
Work the sections in order
Your dashboard tracks every completed lesson and returns you to exactly where you stopped, on any device.
- 4
Reserve your examination seat ($199)
When you are ready to be tested, register your seat for the scored final examination.
- 5
Pass and download your certificate
50 items, 120 minutes, 85% to pass with every safety-critical item correct. Your numbered certificate is valid for 2 years.
Ready to start?
Enrolling takes one click and opens your learning dashboard immediately with every section, knowledge check and desk aid. Already enrolled? Pick up exactly where you left off.