Blue Access for Producers

Downloadable Forms for Individual 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 in portable document format (PDF). To view these files, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® . Other Adobe accessibility tools and information can be downloaded at access.adobe.com .

 

INDIVIDUAL FORMS
Stock # / Date Enrollment Forms and Change Forms New Mexico Form #
82798.1016 Health Application/Change in Coverage  Use this health application for 2017 plans, effective January 1, 2017. td> N/A
475001.1016 Dental Application/Change in Coverage  Use this dental application for 2017 plans, effective January 1, 2017. N/A
Stock # / Date Account Maintenance Forms New Mexico Form #
478841.0916 Automatic Premium Payment Authorization Agreement  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 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
08.01.15 Standard Authorization Form and other HIPAA Privacy Forms N/A
 

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