BlueDirect^® Forms

Our most frequently requested forms are available in Adobe Acrobat PDF format. Just click on the appropriate form, print the form, fill it out, and mail it in. You will need the Adobe^® Reader^® to view the following forms; this can be downloaded free of charge at Adobe's site .

• Individual Application/Change Form for BlueDirect Plans 
  Note: If you have questions regarding this form, please call (505) 837-8787 or toll-free at 1-800-672-9700 and we will be happy to assist you.

• Automatic Premium Payment Authorization Agreement 

• BCBSNM Standard Claim Form 

• BlueCard Worldwide® International Claim Form 

• Prescription Drug Claim Form 

• PrimeMail New Prescription Order Form 

• PrimeMail Refill Prescription Order Form 

• Coordination of Benefits Form 

• Power of Attorney for Health Care Form  — Members can designate someone they trust to make health care decisions if they are unable to do so. Follow instructions on the form.

• Standard Authorization Form and other HIPAA Privacy Forms

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