Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare must now follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) instead of commercial policy guidelines. Many existing BCBSRI policies now apply only to commercial products, requiring providers to reference separate Medicare NCD/LCD policies for BlueCHiP for Medicare coverage decisions.
Action Required
Immediately: Billing team must identify all BlueCHiP for Medicare patients and stop using commercial BCBSRI policies for coverage determinations. Access and reference CMS NCDs and LCDs for all BlueCHiP for Medicare authorization and billing decisions. Update workflows to distinguish between commercial BCBSRI policies and Medicare policies. Train staff to check Medicare-specific coverage policies rather than commercial policies for all BlueCHiP for Medicare claims to avoid denials.