Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2023
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 separate review of Medicare-specific coverage policies.
Action Required
Immediately: Billing team must begin checking BlueCHiP for Medicare NCD and LCD policies separately from commercial BCBSRI policies for all Medicare Advantage claims. Update workflow to verify coverage using CMS guidelines rather than standard BCBSRI commercial policies. Review all pending BlueCHiP for Medicare claims to ensure compliance with appropriate coverage determinations.