Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Mar 1, 2019
We identified it
Jun 20, 2026
Summary
BlueCHiP for Medicare will now follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), which may differ from commercial product policies. Many BCBSRI policies now apply to commercial products only, requiring providers to reference separate BlueCHiP for Medicare NCD and LCD policies.
Action Required
Immediately: Billing team must identify which patients have BlueCHiP for Medicare coverage and verify coverage determinations using CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update billing processes to reference separate BlueCHiP for Medicare policies for coverage verification. Review all pending BlueCHiP for Medicare claims to ensure they align with CMS guidelines rather than commercial policies.