Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jun 1, 2020
We identified it
Jun 19, 2026
Summary
BlueCross BlueShield of Rhode Island (BCBSRI) has updated their policy to clarify that BlueCHiP for Medicare plans must follow CMS guidelines for National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), which may differ from commercial product policies. Many BCBSRI policies now apply only to commercial products, requiring providers to check separate NCD/LCD policies for Medicare coverage determinations.
Action Required
Immediately: Billing team must verify coverage using separate BlueCHiP for Medicare NCD/LCD policies rather than standard BCBSRI commercial policies when billing Medicare Advantage patients. Update workflow to check CMS guidelines and Medicare-specific policies for coverage determinations. Review existing claims processes to ensure compliance with Medicare coverage requirements.