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, 2025
We identified it
Jun 19, 2026
Summary
BlueCross BlueShield of Rhode Island (BCBSRI) has established a new policy requiring their BlueCHiP Medicare Advantage plans to follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), which may differ from their commercial plan policies. Many existing BCBSRI policies now apply only to commercial products, requiring providers to reference separate NCD/LCD policies for Medicare coverage determinations.
Action Required
By April 1, 2025: Billing teams must identify all BlueCHiP Medicare Advantage patients and review CMS NCD/LCD policies instead of standard BCBSRI commercial policies for coverage determinations. Update workflow to check separate Medicare-specific policies for prior authorization, coverage decisions, and medical necessity requirements. Train staff to distinguish between commercial and Medicare Advantage policy references to avoid claim denials.