Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Sep 1, 2022
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare plans 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 coverage decisions.
Action Required
Immediately: Billing team must verify coverage using Medicare NCD/LCD policies instead of commercial BCBSRI policies for all BlueCHiP Medicare claims. Update workflow to check CMS guidelines first, then BCBSRI peer-reviewed determinations only when no NCD/LCD exists. Review all pending BlueCHiP Medicare claims to ensure coverage determination accuracy.