Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Feb 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI BlueCHiP for Medicare will follow CMS national and local coverage determinations (NCDs/LCDs) which may differ from commercial 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 verify coverage determinations for BlueCHiP for Medicare members by referencing CMS NCDs and LCDs rather than standard BCBSRI commercial policies. Update workflow to check BlueCHiP for Medicare's specific NCD and LCD policies for coverage decisions. Failure to follow correct coverage determinations may result in claim denials.