Medicare AdvantageCoverageMedium impact
BlueCHiP for Medicare national and local coverage determinations policy
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Rheumatology, Urology·Provider Update
Effective date
Oct 1, 2018
We identified it
Jun 20, 2026
Summary
BCBSRI updated their BlueCHiP for Medicare policy to align with CMS national and local coverage determinations, with a specific update to medical criteria for Xiaflex (Clostridial Collagenase). The policy clarifies that BlueCHiP Medicare coverage may differ from commercial products and will follow CMS guidelines where applicable.
Action Required
Immediately: Billing team must review current Xiaflex (Clostridial Collagenase) claims for BlueCHiP Medicare patients to ensure they meet updated medical criteria. Verify coverage determinations by checking CMS NCDs/LCDs rather than commercial policy guidelines for all BlueCHiP Medicare services. Update billing procedures to distinguish between BlueCHiP Medicare and commercial coverage policies.