Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Feb 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSRI's BlueCHiP for Medicare plans must 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, with Medicare members requiring separate NCD/LCD policy review.
Action Required
Immediately: Billing team must verify coverage for all BlueCHiP for Medicare claims using CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update workflow to check separate Medicare coverage determinations before submitting claims. Review all pending BlueCHiP for Medicare claims to ensure compliance with CMS guidelines rather than commercial coverage rules.