The Provider Finder provides a list of Blue Cross Medicare Advantage’s current network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).
Some plans require you to obtain a referral from your Primary Care Provider (PCP), or prior authorization from the plan, before receiving certain services. Please refer to your Evidence of Coverage for any referral or authorization requirements.
If you are traveling and are out of the Blue Cross Medicare Advantage service area and need urgent care or emergency care, you should go to the nearest provider to seek care. If you believe you are experiencing a medical emergency, call 911.
You can print a directory from your online search results. If you would like a full provider directory mailed to you, please call the customer service number listed on the back of your member ID card if you are a member. If you are not a member, please use the below link to contact us.
If you have questions about Blue Cross Medicare Advantage, information contained in this Provider Finder or require assistance in selecting a PCP, please call the customer service number listed on the back of your member ID card if you are a member. If you are not a member, please use the link above to contact us.
Language assistance services and information in other formats (large print, accessible electronic formats, other formats) are available, free of charge. Please call the customer service number listed on the back of your member ID card or use the link above to contact us. We are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.
What is the service area for Blue Cross Medicare Advantage?
HMO (Basic) and HMO-SNP (Dual Care) plans are available in the following New Mexico counties: Bernalillo, Sandoval, Torrance and Valencia. HMO (Select), HMO-SNP (Dual Care Plus) and PPO plans are available in the following New Mexico counties: Bernalillo, Dona Ana, Sandoval, Santa Fe, Torrance and Valencia.
The Provider Finder search results are for the entire Blue Cross Medicare Advantage network offered to people that are Medicare eligible and residing in the service area or geographic subset of the service area listed above.
How do you find Blue Cross Medicare Advantage providers that serve your area?
Once you log into Provider Finder your plan, city, state and zip code information will be pre-populated for your current plan type and service area. To search for a provider in your current location you can select a category or type a specific type of generalist, specialist or facility in the space next to Browse by Category. You will have the ability to refine your search for distance, providers accepting new patients, and more. If you are not a current member, you have the same search capabilities as a current member does, but you will have to populate the plan type and service area location you are interested in researching. To search for a provider in an alternate location, just type over the pre-populated information for city, state and zip code.
If you are an HMO member
Please choose one of our network providers listed in this Provider Finder to be your Primary Care Physician (PCP). Generally, you must get your health care services from your PCP. A PCP is a doctor who is a family practitioner, internist or geriatric physician. The PCP is trained to provide general medical care. The PCP you select provides or manages your health care. The PCP also helps you make informed decisions about your care. When necessary the PCP makes referrals to specialists, generally within your medical group network.
The network providers listed in this Provider Finder have agreed to provide you with your health care services. You may go to any of our network providers listed in this Provider Finder; however, some services may require a referral. If you have been going to one network provider, you are not required to continue to go to the same provider. In some cases, you may get covered services from non-network providers. If you require medical care beyond the scope of your PCP, the PCP will coordinate with providers most
appropriate to render the medical treatment. It is important to note that the PCP belongs to a network. The PCP has certain network specialists and hospitals that they use for coordinated specialty, diagnostic and hospital medical care. The specialist and hospitals that the PCP may refer you to will be within the PCP network affiliation.
You may be financially responsible to pay for some or possibly all services if you choose to go to a doctor outside of your affiliated medical group without authorization from your PCP. Your PCP will coordinate the authorization process. With the exception of emergencies, urgent care, and out-of-area renal dialysis or other services, it may cost more to get care from out-of-network providers. Keep in mind, if you obtain routine care from out-of-network providers neither Medicare nor Blue Cross Medicare Advantage will be responsible for the costs.
You do not need prior authorization to seek medical help in an urgent or emergency situation. The physician
treating your emergency needs will discuss your condition with your Primary Care Physician. When your condition is stable, the physicians will coordinate the transfer of your care back to your Primary Care Physician network.
If an out-of-network provider asks you to pay for covered services you receive, please call the customer service number on the back of your member ID or send the bill(s) with a note explaining the situation to:
Blue Cross Medicare Advantage
P.O. Box 11968
Albuquerque, NM 87192
If you are a PPO member
Blue Cross Medicare Advantage is a Preferred Provider Organization (PPO) plan. All Blue Cross Medicare Advantage plan providers are available to members through self-referral, with the exception of services that require prior authorization.
The network providers listed in the Provider Finder have agreed to provide you with your health care services. You may go to any of our network providers listed in the Provider Finder. If you have been going to one network provider, you are not required to continue to go to the same provider. In some cases, you may get covered services from non‑network providers. If you use providers within the Blue Cross Medicare Advantage network your copay and/or coinsurance will be less than going to non-network providers.
Out-of-network/non-contracted providers are under no obligation to treat Blue Cross Medicare Advantage members, except in emergency situations. Please call our customer service number on the back of your member ID card or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
You do not need prior authorization to seek medical help in an urgent or emergency situation. If you obtain routine care, other than Emergency Care services, from out-of-network providers, your cost of care may be more.
If an out-of-network provider asks you to pay for covered services you receive, please call the number listed on the back of your member ID or send the bill(s) with a note explaining the situation to:
Blue Cross Medicare Advantage
P.O. Box 11968
Albuquerque, NM 87192
HMO, PPO, and HMO Special Needs Plans provided by Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract and a contract with the New Mexico Medicaid program. Enrollment in HCSC’s plans depends on contract renewal.
Such services are funded in part with the State of New Mexico.