Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare plans 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, requiring separate reference to Medicare NCD/LCD policies for BlueCHiP Medicare coverage decisions.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP Medicare patients using CMS NCD/LCD policies rather than standard BCBSRI commercial policies. Update workflow to check separate Medicare coverage determinations before submitting claims. Reference BlueCHiP Medicare's NCD and LCD policies at BCBSRI website for all coverage questions. Failure to follow correct coverage guidelines will result in claim denials.