Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Dec 1, 2018
We identified it
Jun 20, 2026
Summary
BlueCross BlueShield Rhode Island (BCBSRI) updated their policy stating that BlueCHiP for Medicare plans must follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), which may differ from their commercial product policies. Many existing BCBSRI policies now apply only to commercial products, requiring separate reference to Medicare-specific coverage determinations.
Action Required
Immediately: Billing team must verify coverage separately for BlueCHiP for Medicare versus commercial BCBSRI plans. Stop applying commercial BCBSRI policies to Medicare patients. Reference CMS NCDs/LCDs and the specific BlueCHiP for Medicare National and Local Coverage Determinations policy for all Medicare coverage questions. Update billing workflows to distinguish between commercial and Medicare plan policies.