Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Apr 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI's 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 providers to reference separate Medicare NCD/LCD policies for coverage decisions.
Action Required
Immediately: Billing team must identify all BlueCHiP for Medicare patients and verify coverage using CMS NCDs/LCDs rather than standard BCBSRI commercial policies. Update prior authorization and coverage verification workflows to reference Medicare-specific policies. Review current Medicare claims for potential coverage differences and resubmit if necessary.