CPES is the first provider enrollment certification on the market, and it gives MSPs and those already practicing provider enrollment an opportunity to demonstrate their skills and knowledge of this topic.

The Certified Provider Enrollment Specialist (CPES) is typically employed or contracted by healthcare organizations including, but not limited to hospitals (health systems), ambulatory care settings, group practices, revenue cycle management or billing agencies.

Why Earn Your CPES Certification?

• Becoming a Certified Provider Enrollment Specialist (CPES) is a valuable step for professionals in the medical staff, credentialing, and provider enrollment services field.
• The CPES certification, offered by the Certification Commission of the National Association Medical Staff Services (CCN), is the first and only Provider Enrollment certification in the industry.
• CPES Certificants demonstrate their competency and dedication to maintaining high standards in provider enrollment services, positioning themselves for career advancement and increased credibility in the industry.
• By obtaining this certification, professionals validate display their knowledge and expertise but also enhance their professional development and recognition in this specialized area.
• By achieving you CPES designation, you gain confidence and demonstrate professional competence in the application of your knowledge.
• CPES certificants will stand out to future employers in the applicant pool.

Curious about what sets NAMSS certification apart? 

Read this article to learn the key differences between the NAMSS certification programs and certificate programs.

 

A CPES is an integral part of a Healthcare Organization’s team whose responsibilities include:

• Knowledge of practitioner and organizational enrollment terminology and documents
  required for enrollment.
• Delegated and non-delegated payor enrollment with health plans, meeting health plan
  requirements, and knowledge of health plan accreditation standards.
• Maintaining compliance with Medicare enrollment, revalidation, reassignment of benefits,
  and ongoing enrollment management.
• Collecting and maintaining an accurate practitioner database.
• Setting-up and maintaining CAQH practitioner profiles, organization profiles, and practice manager accounts.

CPES Examination Eligibility Requirements

At the time of application, a candidate must have been or currently be employed or contracted in the profession of provider enrollment for at least 12 consecutive months in the last 24 months and have a total of three years’ experience within the past five years.

Learn More About CPES

Certified Provider Enrollment Specialist (CPES) Certification Frequently Asked Questions

Who is a CPES Certificant?

• A Certified Provider Enrollment Specialist is typically employed or contracted by healthcare organizations including, but not limited to hospitals (health systems), ambulatory care settings, group practices, revenue cycle management or billing agencies. Those professionals employed at the level to which the title of Provider Enrollment Coordinator, Provider Enrollment Specialist and Credentialing Coordinator would appropriately apply.  Whose responsibilities include:
  • Knowledge of practitioner and organizational enrollment terminology and documents required for enrollment.
  • Delegated and non-delegated payor enrollment with health plans, meeting health plan requirements, and knowledge of health plan accreditation standards.
  • Maintaining compliance with Medicare enrollment, revalidation, reassignment of benefits, and ongoing enrollment management.
  • Collecting and maintaining an accurate practitioner database.
  • Setting-up and maintaining CAQH practitioner profiles, organization profiles, and practice manager accounts.

Who is eligible to sit for the CPES examination?

• At the time of application, a candidate must have been or currently be employed or contracted in the profession of provider enrollment for at least 12 consecutive months in the last 24 months and have a total of three years’ experience within the past five years.

When will the CPES exam be offered?

• The first exam will be offered in the beginning in the Fall 2025 testing window.

What will the Examination Content be?

• Enrollment 60%
• Ongoing Monitoring and Compliance 22%
• Supporting Departmental Operations 19%

The exam content will also be listed in the 2025 Canidate Handbook.

How many questions will there be on the CPES exam?

• There will be 150 questions on the exam.

What resources can I use to prepare for the exam?

• The list of Reference Materials used to write the exam questions will be available in the 2025 Candidate Handbook.

How was the CPES certification exam created?

• We follow a psychometrically sound assessment development process administered by our testing vendor. Since 2023, the following test development activities have occurred:
  • Job Task Analysis:  A representative group of volunteers who meet the stated test development volunteer criteria will be recruited to participate in the JTA test development activity. The testing vendor representative will train and lead the group through a set of exercises that will result in a current blueprint (exam content outline) for a certification examination. After the blueprint is formulated by the subject matter experts, a survey of certified individuals or non-certified industry professionals for a developing certification, will be conducted to determine the percentages of each area of the blueprint to which the exam will be constructed. The survey will also collect information on the percentage of certificants/ non-certified industry professionals for developing certification program working with the various accrediting bodies. A revised blueprint (exam content outline) will be presented to and approved by the CCN. The approved blueprint (exam content outline) will be communicated to the NAMSS Board, NAMSS Education Committee, NAMSS membership, and it will be added to the candidate handbook.
  • Item writing: Subject matter experts are recruited by the Test development team to draft new and original items (questions) to meet the quality and quantity of items needed for the item bank, as identified by the CCN testing vendor. Item writing events will be conducted at least once a year and led by the CCN testing vendor. All Item Writers have been trained to write legally defensible items, supported by current regulatory requirements, and focused on the examination blueprint.  All items undergo a rigorous multi-tiered mentor approval process before they are accepted to the item bank.

• The following activities will occur prior to the Fall 2025 testing window:

  • Exam Assembly: Creation of the exam form is prepared by our testing vendor and the appropriate number of items from each content area are selected as required by the examination blueprint. The draft form of the exam is reviewed and approved by SMEs. All questions are reviewed for accuracy, currency with standards, duplication of questions, technical errors, and references.
  • Standard Setting: The standard setting protocol is designed to develop a criterion-reference standard. The proposed performance standard (cut score) is reported back to the CCN board for final determination of the cut score. A representative group of volunteers who meet the test development volunteer criteria are led through the standard setting exercise by the CCN vendor representative.

Will the recertification process be conducted the same as the CPCS and CPMSM?

• The CPES certification will require certificants to renew their credential every three years. If the CPES is the second or third NAMSS certification earned by an individual, the CPES will fall into the same recertification cycle as the existing certification(s).

Additional CPES Exam Information:

If you have provider enrollment experience and are interested in volunteering for future test development events, volunteering, please submit your interest through the volunteer application within this QR code:

Volunteer Application

Consider renewing or applying for a NAMSS membership prior to applying for the exam to receive the NAMSS member rate. If you do not renew or apply before submitting your application, you will not be eligible for the NAMSS member rate.

NOTICE: As a reminder, NAMSS is no longer mailing printed paper certificates. Digital badges and a PDF certificate are available via Credly for new and renewal certificants. Learn more.

CPES® is registered in the U.S. Patent and Trademark Office as a service mark of National Association Medical Staff Services.