New Provider Designations and Services Forms for Provider Onboarding Applications

November 19, 2021

Blue Cross and Blue Shield of New Mexico (BCBSNM) has implemented a new requirement for provider onboarding applications. Providers submitting onboarding applications will also need to attach a Provider Designations and Services Form to their application when submitting your application. This does not apply to currently contracted behavioral health rostered and/or delegated provider groups that are adding new providers.

Provider Designations and Services Forms are used to populate our provider directories to help our members find the care they need and provide data for required state and federal reporting.

The Provider Designations and Services Forms are available on our website, bcbsnm.com/provider, in the "How to Join BCBSNM Provider Networks" section under the "Network Participation" tab. There are different forms for each the following provider types:

  • Groups, Clinics and Agencies
    • Physical Health
    • Behavioral Health
  • Facilities
    • Physical Health
    • Behavioral Health
  • Practitioners
    • Physical Health
    • Behavioral Health
  • Long-Term Care

Please attach the appropriate completed form(s) with your Provider Onboarding application when submitting your application. Your application will be rejected if it is not accompanied by the appropriate Provider Designations and Services Form(s).

If you have any questions, or if you need additional information, please contact your local BCBSNM Provider Network Representative.