Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare must now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policy guidelines. Many BCBSRI policies now apply only to commercial products, requiring separate reference to Medicare-specific NCD/LCD policies.
Action Required
Immediately: Billing team must verify coverage using BlueCHiP for Medicare NCD/LCD policies rather than commercial BCBSRI policies for all Medicare Advantage claims. Update workflow to check separate Medicare coverage determinations before submitting claims. Review current pending Medicare Advantage claims to ensure they meet CMS guidelines rather than commercial policy requirements.