Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Mar 1, 2020
We identified it
Jun 19, 2026
Summary
BlueCHiP for Medicare now follows CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) instead of commercial policy rules. Many BCBSRI policies now apply only to commercial products, requiring separate reference to Medicare-specific NCD and LCD policies for BlueCHiP Medicare coverage decisions.
Action Required
Immediately: Billing team must separate BlueCHiP for Medicare claims from commercial claims processing. Stop applying commercial BCBSRI policies to BlueCHiP Medicare members. Reference CMS NCDs and LCDs for coverage determinations instead of standard BCBSRI policies. Update billing software to flag BlueCHiP Medicare claims for separate policy review. Train staff to check Medicare-specific coverage policies before submitting claims.