Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Sep 1, 2019
We identified it
Jun 20, 2026
Summary
BCBS Rhode Island has updated their BlueCHiP for Medicare policy to clarify that they must follow CMS national and local coverage determinations (NCDs/LCDs), which may differ from their commercial policies. Many BCBSRI policies now apply only to commercial products, requiring separate reference to Medicare NCD/LCD policies for coverage determinations.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP for Medicare claims by referencing CMS NCDs and LCDs instead of standard BCBSRI commercial policies. Update workflow to check Medicare-specific coverage determinations when processing BlueCHiP for Medicare claims. Staff should access BlueCHiP for Medicare's NCD and LCD policies separately from commercial policy references.