Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Nov 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI BlueCHiP for Medicare plans must now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policy guidelines. Many existing BCBSRI policies now apply only to commercial products, requiring separate coverage review for Medicare members.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP for Medicare members using CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update workflow to check separate Medicare coverage determinations before submitting claims. Review denied claims from BlueCHiP Medicare members as coverage rules may now differ significantly from commercial plans.