Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 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 BCBSRI policies now apply only to commercial products, with separate NCD/LCD policies governing BlueCHiP for Medicare coverage decisions.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP for Medicare members using NCD/LCD policies instead of standard BCBSRI commercial policies. Update authorization and coverage verification workflows to check Medicare-specific guidelines. Review all pending BlueCHiP for Medicare claims to ensure they meet CMS coverage requirements rather than commercial policy standards.