Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2022
We identified it
Jun 19, 2026
Summary
BlueCross BlueShield of Rhode Island (BCBSRI) will now follow CMS national and local coverage determinations (NCDs/LCDs) for BlueCHiP Medicare plans, which may differ from commercial plan policies. Many existing BCBSRI policies now apply only to commercial products, requiring providers to reference separate Medicare NCD/LCD policies for coverage decisions.
Action Required
Immediately: Billing team must identify which services require different coverage verification for BlueCHiP Medicare vs commercial plans. Update verification workflows to check CMS NCDs/LCDs for Medicare patients rather than standard BCBSRI policies. Train staff to reference separate Medicare coverage policies when determining benefits for BlueCHiP Medicare members.