Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 1, 2020
We identified it
Jun 19, 2026
Summary
BCBSRI BlueCHiP for Medicare plans must now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policy guidelines. Many BCBSRI policies now apply to commercial products only, requiring separate review of Medicare-specific coverage policies.
Action Required
Immediately: Billing team must separate BlueCHiP for Medicare claims from commercial claims processing. Review all pending Medicare Advantage claims against CMS NCDs/LCDs rather than standard BCBSRI commercial policies. Update billing workflows to check Medicare-specific coverage determinations before submitting claims. Verify coverage eligibility using BlueCHiP Medicare policies, not commercial BCBSRI policies.