Blue Access for Producers

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 .

MEDICARE FORMS
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
 

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