Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Dec 1, 2020
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare must 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 coverage decisions.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP for Medicare claims using CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update workflow to check separate Medicare coverage policies before submitting claims. Review all pending BlueCHiP for Medicare claims to ensure they meet CMS guidelines rather than commercial policy requirements.