Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare will now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policy guidelines. Many existing BCBSRI policies now apply to commercial products only, requiring separate reference to Medicare NCD/LCD policies for BlueCHiP Medicare coverage decisions.
Action Required
By April 1, 2026: Billing team must establish separate workflow for BlueCHiP Medicare claims verification. Stop using commercial BCBSRI policies for Medicare Advantage coverage decisions. Create process to check CMS NCDs/LCDs for BlueCHiP Medicare coverage determinations. Update staff training to distinguish between commercial and Medicare policy requirements. Failure to follow correct guidelines may result in coverage denials.