Blue Access for Producers

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Downloadable Forms for Large Groups (101+ Employees)


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.

To review and sign your request now electronically, select the sign now option below. Or you can download and save the form, to review and sign at a later date.

Enrollment Forms and Change Forms

Form Name Digital Form Download
2018 Group Enrollment Application/Change Form – use this form to apply for group coverage effective 1/1/2018 N/A download form Acrobat PDF
2017 Group Enrollment Application/Change Form – use this form to apply for group coverage (through 12/31/2017) or make changes to an existing BCBSNM policy sign now External Link download form Acrobat PDF
2017 Group Enrollment Application/Change Form – Spanish N/A download form Acrobat PDF
Affidavit of Domestic Partnership sign now External Link download form Acrobat PDF
Away From Home Care Guest Membership Application N/A download form Acrobat PDF
Disabled Dependent Certification Form sign now External Link download form Acrobat PDF
Statement of Termination of Domestic Partnership N/A download form Acrobat PDF

 

Medicare Secondary Payer (MSP) Form and Information

Form Name Digital Form Download
Annual MSP Employer Acknowledgement Form with Instructions on Completing the Form N/A download form Acrobat PDF
Information Regarding the Medicare as Secondary Payer Statute N/A download form Acrobat PDF
MSP Fact Sheet N/A download form Acrobat PDF

 

Miscellaneous Forms

Form Name Digital Form Download
Coordination of Benefits Form N/A download form Acrobat PDF
Medicare Coordination of Benefits Form N/A download form Acrobat PDF

 

Legal / HIPAA Forms

Form Name Digital Form Download
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 download form Acrobat PDF
Standard Authorization Form and other HIPAA Privacy Forms N/A N/A