Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Mar 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, with BlueCHiP Medicare requiring separate NCD/LCD policy review.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP for Medicare members using CMS NCDs and LCDs rather than BCBSRI commercial policies. Review all pending and future BlueCHiP Medicare claims to ensure they meet CMS guidelines. Update billing workflows to check separate Medicare coverage policies before submitting claims to avoid denials.