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BlueCHiP for Medicare national and local coverage determinations policy
Act
by Oct 1, 2026
Effective date
Oct 1, 2026
Identified
Oct 1, 2026
Summary
BlueCHiP for Medicare will now strictly follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) rather than applying independent policy determinations. Many BCBSRI policies previously applicable to both commercial and Medicare products are now commercial-only; billing teams must consult BlueCHiP for Medicare's specific NCD/LCD policies for Medicare coverage decisions to avoid claim denials.
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What to do
by Oct 1, 2026 · 6 steps
01Billing and coding teams must implement the following.
02Establish a process to distinguish between BlueCHiP for Medicare claims and commercial claims at the point of entry.
03For all BlueCHiP for Medicare claims, reference only CMS-published NCDs and LCDs (not BCBSRI commercial policies) to determine coverage and billing requirements.
04Update billing system edits and prior authorization workflows to route Medicare claims to CMS guidelines rather than legacy BCBSRI policies.
05Train all billing staff, coders, and providers that BCBSRI policies posted on the website may now apply to commercial products only.
06Create a reference guide or bookmark for staff linking to BlueCHiP for Medicare's NCD and LCD policies.
If missed: Failure to align with CMS guidance will result in improper denials or payment recoupments from Medicare.
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 Sep 1, 2026 · Provider UpdateBlueCHiP for Medicare national and local coverage determinations policyHighEffective Aug 1, 2026 · Provider UpdateBlueCHiP for Medicare national and local coverage determinations policyMediumEffective Jul 1, 2026 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list