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, 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 coverage verification for Medicare Advantage patients.
Action Required
Immediately: Billing team must verify coverage separately for BlueCHiP Medicare patients using CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update workflow to check Medicare-specific coverage determinations before submitting claims. Train staff to reference BlueCHiP Medicare NCD/LCD policies instead of commercial policies for Medicare Advantage patients.