Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jun 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI BlueCHiP for Medicare will follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policies. Many existing BCBSRI policies now apply only to commercial products, with BlueCHiP Medicare following separate CMS guidelines.
Action Required
Immediately: Billing team must verify coverage for BlueCHiP Medicare members using CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Check BCBSRI's BlueCHiP Medicare NCD/LCD policy documents before submitting claims. Update workflows to distinguish between BlueCHiP Medicare and commercial coverage rules.