Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI BlueCHiP for Medicare will 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 reference to Medicare NCD/LCD policies for coverage decisions.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP for Medicare members using CMS NCDs and LCDs instead of commercial BCBSRI policies. Update workflow to check separate Medicare coverage policies for all BlueCHiP for Medicare claims. Review current pending claims to ensure compliance with Medicare guidelines rather than commercial policies.