Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
BlueCHiP for Medicare (BCBSRI's Medicare Advantage plan) will now follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) instead of commercial policy guidelines. Many existing BCBSRI policies now apply only to commercial products, requiring different coverage criteria for Medicare Advantage members.
Action Required
Immediately: Billing team must verify coverage using CMS NCDs and LCDs for all BlueCHiP for Medicare claims instead of standard BCBSRI commercial policies. Update billing workflows to check Medicare-specific coverage determinations before submitting claims. Failure to follow CMS guidelines may result in claim denials.