Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Dec 1, 2022
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 reference to Medicare NCD/LCD policies for BlueCHiP Medicare coverage decisions.
Action Required
Immediately: Billing team must stop using commercial BCBSRI policies for BlueCHiP Medicare claims. Reference CMS NCDs and LCDs for coverage determinations instead of standard BCBSRI policies. Update workflow to check Medicare-specific coverage policies before submitting BlueCHiP Medicare claims. Failure to follow Medicare guidelines may result in claim denials.