Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 1, 2026
We identified it
Jun 19, 2026
Summary
BCBSRI's BlueCHiP for Medicare plans will now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policy guidelines. Many existing BCBSRI policies now apply only to commercial products, with Medicare Advantage members subject to different coverage rules.
Action Required
By May 1, 2026: Billing team must update workflows to reference CMS NCDs and LCDs for all BlueCHiP for Medicare claims instead of standard BCBSRI commercial policies. Create separate coverage verification processes for Medicare Advantage vs commercial patients. Monitor BCBSRI website for ongoing NCD/LCD updates as policies will be continuously revised.