Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 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, creating separate coverage rules for Medicare Advantage members.
Action Required
Immediately: Billing team must identify all BlueCHiP for Medicare claims and verify coverage using CMS NCDs/LCDs instead of standard BCBSRI commercial policies. Review existing authorization processes and update billing system to reference Medicare-specific coverage determinations. Check BCBSRI website for BlueCHiP Medicare NCD/LCD policies before submitting claims to avoid denials based on outdated commercial coverage rules.