Medicare AdvantageCoverageHigh impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI BlueCHiP for Medicare will now follow CMS national and local coverage determinations (NCDs/LCDs) instead of commercial policy guidelines. Many existing BCBSRI policies now apply only to commercial products, requiring separate review of Medicare-specific coverage policies.
Action Required
Immediately: Billing team must verify coverage using BlueCHiP for Medicare NCD/LCD policies rather than commercial BCBSRI policies for all Medicare Advantage claims. Review current claim denials and resubmit if they were processed under incorrect policy guidelines. Update billing procedures to reference Medicare-specific coverage determinations for BlueCHiP members.