Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Nov 1, 2024
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 only to commercial products, requiring different coverage criteria for Medicare patients.
Action Required
Immediately: Billing team must verify coverage criteria separately for BlueCHiP Medicare vs commercial patients. Review all pending Medicare claims against CMS NCDs/LCDs rather than standard BCBSRI policies. Update prior authorization workflows to reference Medicare-specific coverage determinations. Contact BCBSRI for BlueCHiP Medicare NCD/LCD policies when commercial policies no longer apply.