Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Sep 1, 2021
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 policies. Many existing BCBSRI policies now apply to commercial products only, with BlueCHiP for Medicare having separate coverage rules that may be more or less restrictive than commercial plans.
Action Required
Immediately: Billing team must verify coverage using BlueCHiP for Medicare's NCD and LCD policies rather than standard BCBSRI commercial policies when billing Medicare Advantage patients. Update workflow to check CMS coverage determinations before submitting claims. Review existing authorizations and coverage decisions for BlueCHiP Medicare patients as they may differ from commercial approvals.