Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
BlueCross BlueShield of Rhode Island (BCBSRI) has updated its BlueCHiP for Medicare policy to strictly follow CMS national and local coverage determinations (NCDs/LCDs). Many BCBSRI policies now apply only to commercial products, with separate Medicare coverage rules that may differ from commercial policies.
Action Required
By June 1, 2026: Billing team must identify all BlueCHiP for Medicare patients and verify coverage determinations against CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update billing workflows to reference Medicare-specific coverage policies for these members. Review current authorizations and coverage decisions for BlueCHiP Medicare patients to ensure compliance with CMS guidelines.