Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Nov 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI's BlueCHiP for Medicare now follows CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policies. Many BCBSRI policies now apply to commercial products only, with separate NCD/LCD policies governing BlueCHiP for Medicare coverage.
Action Required
Immediately: Billing team must verify coverage using BlueCHiP for Medicare's NCD and LCD policies instead of commercial BCBSRI policies when billing Medicare Advantage members. Update billing workflows to reference CMS guidelines for BlueCHiP for Medicare claims. Review current procedures to identify services that may have different coverage criteria between commercial and Medicare Advantage plans.