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BlueCHiP for Medicare national and local coverage determinations policy
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jul 1, 2026
Summary
BlueCHiP for Medicare is clarifying its coverage determination process by stating it will follow CMS national and local coverage determinations (NCDs/LCDs) for Medicare plans, which may differ from commercial policies. Many existing BCBSRI policies now apply to commercial products only, requiring billing teams to reference separate BlueCHiP for Medicare NCD/LCD policies instead.
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What to do
by Jul 1, 2026 · 6 steps
01Billing team must implement a dual-policy lookup system that distinguishes between BlueCHiP for Medicare and commercial product coverage determinations.
02For all Medicare claims: Reference BlueCHiP for Medicare's NCD and LCD policies (not legacy BCBSRI commercial policies).
03For commercial claims: Continue using existing BCBSRI policies.
04Update billing software decision trees and prior authorization workflows to separate Medicare from commercial logic.
05Train billing and credentialing staff to always verify whether a claim is Medicare or commercial before applying coverage rules.
06Review current claim denials—Medicare claims may have been incorrectly denied under commercial policy rules and may warrant appeal/resubmission under correct NCD/LCD guidance.
If missed: Failure to apply correct CMS guidelines will result in improper denials and appeals.
Original notice
BlueCHiP for Medicare national and local coverage determinations policy
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →BlueCHiP for Medicare national and local coverage determinations policyMediumEffective Nov 1, 2026 · Behavioral Health / FacilityBlueCHiP for Medicare national and local coverage determinations policyHighEffective Oct 1, 2026 · Provider UpdateBlueCHiP for Medicare national and local coverage determinations policyHighEffective Sep 1, 2026 · Provider UpdateBlueCHiP for Medicare national and local coverage determinations policyHighEffective Aug 1, 2026 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list