Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Mar 1, 2023
We identified it
Jun 19, 2026
Summary
BlueCross BlueShield of Rhode Island (BCBSRI) updated their BlueCHiP for Medicare policy to strictly follow CMS national and local coverage determinations (NCDs and LCDs). This means BlueCHiP for Medicare policies may now differ significantly from commercial product policies, with many BCBSRI policies now applying to commercial products only.
Action Required
Immediately: Billing team must verify coverage requirements separately for BlueCHiP for Medicare versus commercial BCBSRI plans. Check CMS NCDs and LCDs for BlueCHiP for Medicare coverage determinations rather than relying on commercial BCBSRI policies. Update billing workflows to distinguish between BlueCHiP for Medicare and commercial BCBSRI plan requirements, as coverage may differ significantly between these plan types.