Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2020
We identified it
Jun 19, 2026
Summary
BlueCHiP for Medicare will now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policies. Many existing BCBSRI policies now apply only to commercial products, and providers must refer to separate NCD/LCD policies for BlueCHiP Medicare coverage decisions.
Action Required
Immediately: Billing team must identify all BlueCHiP Medicare patients and verify coverage using CMS NCDs/LCDs instead of standard BCBSRI commercial policies. Update billing workflows to check separate BlueCHiP Medicare NCD/LCD policies before submitting claims. Review all pending BlueCHiP Medicare claims to ensure compliance with CMS guidelines rather than commercial coverage rules.