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, 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 coverage verification for Medicare members.
Action Required
Immediately: Billing team must verify coverage using BlueCHiP for Medicare NCD/LCD policies instead of commercial BCBSRI policies for all Medicare Advantage members. Update billing workflows to check separate coverage determinations for Medicare vs commercial patients. Review all pending Medicare Advantage claims to ensure they follow CMS guidelines rather than commercial policies.