Update Your Provider Information

For Blue Cross and Blue Shield of New Mexico contracted or non-contracted providers only.

All other providers — please contact your local Blue Cross and Blue Shield Plan.
Change requests for other Plans/States will not be forwarded.

Use this form if you are changing your group/practice information such as:

  • Moved to another location
  • Left a group practice
  • Changed your phone number
  • Changed your email address
  • Retired
  • Any other changes to your practice information
  • Office hours — Due to the new provider directory requirements, office hours must reflect each practice location, facility and individual provider. If you have not already confirmed your office hours, Provider Finder® will list your hours as 8 a.m. to 5 p.m. If this is an inaccurate representation of your hours please update in the office days and hours field below or contact us at 800-567-8540.

Fill out the fields below so we can update your provider record to ensure that you receive critical communications and efficient reimbursement.

If you need to change your tax identification number, please complete the following:


Please tell us what information you are changing:

Effective date of change:


Requestor/Contact:
(Name, Phone, Email)


Provider Name:


NPI Number:


Practice Name:


Accepting New Patients

Closed
Accepting
Existing Patients Only
Existing Patients & Family Only


Mailing Address: (Correspondence)
(Address, City, State, Zip Code, Phone/Fax)


Billing Address: (Billing/Payments)
(Address, City, State, Zip Code, Phone/Fax)


Physical Address:
(Address, City, State, Zip Code, Phone/Fax)


Office Days and Hours:
(include days and hours for each location)


*Tax ID Number:

* Tax identification number changes require the submission of a 147C letter.


Email Address:

Office Manager:
Physician:
Billing Manager:
Other/Who:








If you have questions, call your BCBSNM Network Services Provider Representative at 505-837-8800 or toll-free at 800-567-8540.



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