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, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI announced that BlueCHiP for Medicare will now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policies. Many existing BCBSRI policies now apply only to commercial products, requiring providers to reference separate Medicare NCD/LCD policies for coverage decisions.
Action Required
Immediately: Billing team must stop using commercial BCBSRI policies for BlueCHiP for Medicare claims. Reference CMS NCDs and LCDs for coverage determinations instead. Update authorization workflows to distinguish between commercial and Medicare coverage policies. Train staff to verify coverage using Medicare-specific policies rather than commercial guidelines to prevent claim denials.