Downloadable Forms for Medicare Products
Here are some commonly used forms for conducting business with Blue Cross and Blue Shield of New Mexico (BCBSNM). To access more downloadable forms, please log in to Blue Access for Producers (BAP).
The forms below are available as PDF files. Just click on the appropriate form and print it out, then fill out the form and mail it in. You will need the Adobe® Reader® to view the following forms. Download this free of charge at Adobe's site .
|Stock # / Date||Enrollment Forms and Change Forms||New Mexico Form #|
|81940.0811||Application for Medicare Supplement Insurance Coverage (Guaranteed Issue)||NM-MS-APP-GI-2011-R1|
|81791.0711||Application for Medicare Supplement Insurance Coverage (Underwritten)||NM-MS-APP-UW-2011-R1|
|81992.0911||Medicare Supplement Notice of Replacement||NM-MS-NOR-2011-R1|
|M585 (Rev 11/07)||Medicare Supplement Other Coverage Questionnaire||N/A|
|31752.0311||Medicare Supplement ezBlue Payment Option Authorization Form||N/A|
|Stock # / Date||Miscellaneous Forms||New Mexico Form #|
|--||Medicare Coordination of Benefits Form||N/A|
|Stock # / Date||Other Plan Information||New Mexico Form #|
|--||Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare||N/A|
|Stock # / Date||Legal / HIPAA Forms||New Mexico Form #|
|--||Power of Attorney for Health Care Members can designate someone they trust to make health care decisions if they are unable to do so. Follow instructions on the form.||N/A|
|09.01.13||Standard Authorization Form and other HIPAA Privacy Forms||N/A|