Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jun 1, 2025
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 providers to reference separate Medicare NCD/LCD policies for coverage decisions.
Action Required
By June 1, 2025: Billing team must establish separate workflow for BlueCHiP for Medicare claims verification. Stop using commercial BCBSRI policies for Medicare coverage determinations. Create process to check CMS NCDs/LCDs for coverage decisions on all BlueCHiP for Medicare services. Update staff training to distinguish between commercial and Medicare policy requirements. Failure to follow correct coverage policies will result in claim denials.