Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Apr 1, 2022
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare plans 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 Medicare coverage rules.
Action Required
Immediately: Billing team must verify coverage using BlueCHiP for Medicare's NCD and LCD policies instead of commercial BCBSRI policies for all Medicare Advantage claims. Update billing workflows to reference CMS guidelines for coverage determinations. Stop using commercial policy references for Medicare Advantage authorizations and coverage decisions.