Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 1, 2019
We identified it
Jun 20, 2026
Summary
BlueCross BlueShield of Rhode Island (BCBSRI) will now follow CMS guidelines for national and local coverage determinations (NCDs/LCDs) for their BlueCHiP Medicare plans, which may result in different coverage policies compared to their commercial products. Many BCBSRI policies now apply only to commercial products, requiring providers to reference separate Medicare NCD/LCD policies for coverage determinations.
Action Required
Immediately: Billing team must verify coverage using separate BlueCHiP Medicare NCD/LCD policies rather than standard BCBSRI commercial policies when billing Medicare Advantage patients. Update workflow to check CMS guidelines and Medicare-specific policies for coverage determinations. Contact BCBSRI for Medicare-specific policy guidance when standard commercial policies no longer apply.