Blue Access for Producers

Downloadable Forms for Small Group 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 .

SMALL GROUP FORMS (Groups of 2-50)
These downloadable forms are for use with off-exchange small group products.
Stock # / Date Proposal Forms New Mexico Form #
-- Request for Quote Proposal/Census Form (Groups 2-50)  N/A
Stock # / Date Enrollment Forms and Change Forms New Mexico Form #
NM81797 DP Affidavit Affidavit of Domestic Partnership  N/A
M469 9/07 Disabled Dependent Certification Form  N/A
81809.0913 2014 Group Enrollment/Change Application  - (for groups enrolling on or after 1/1/14) N/A
475811.1213 2014 Group Enrollment/Change Application - Spanish  - (for groups enrolling on or after 1/1/14) N/A
81809.1011 Group Enrollment/Change Application  - (for groups with coverage prior to 1/1/14) N/A
81809.1011 Group Enrollment/Change Application - Spanish  - (for groups with coverage prior to 1/1/14) N/A
Stock # / Date Miscellaneous Forms New Mexico Form #
CS01 10/07 Coordination of Benefits Form  N/A
-- Medicare Coordination of Benefits Form  N/A
Stock # / Date Medicare Secondary Payer (MSP) Form and Information New Mexico Form #
21127.0913 Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form  N/A
21093.0609 Information Regarding the Medicare as Secondary Payer Statute  N/A
82284.0612 MSP Fact Sheet  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
 

Form Finder

Quickly search for or browse forms.