Blue Cross and Blue Shield of New Mexico (BCBSNM) welcomes you to apply to join our provider networks. We contract with health care professionals, facilities and other providers to form our provider networks which are essential for delivering quality, accessible and cost-effective health care services to our members.
We developed a new process for professional provider groups and solo practitioners to make joining our networks even easier. Professional provider groups and solo practitioners will need to follow the steps outlined below to apply to join. We look forward to working with you!
FIVE EASY STEPS TO JOIN!
Step 1 — Complete an application (Professional Provider Groups and Solo Practitioners).
To apply to join our networks, you will need to complete the Provider Onboarding Form .
Step 2 — Submit a signed contract.
If you meet eligibility requirements, you will be sent a contract for participating in our provider networks.
Step 3 — Become credentialed.
Providers who participate in our networks are required to complete the credentialing process as necessary, prior to acceptance.
Our credentialing requirements are derived from, and in compliance with, applicable New Mexico and National Committee for Quality Assurance (NCQA) credentialing standards.
Step 4 — Review Process.
After we review your Provider Onboarding Form, your signed contract and you complete the credentialing process, we will let you know if you are accepted into our networks. If you are accepted, you will receive a welcome letter with your network effective date.
Step 5 — Get connected.
Once you are part of our networks, we strongly encourage you to use all available electronic options for electronic data interchange (EDI) transactions to help ensure timeliness, accuracy and security of claims-related information including:
- Electronic Data Interchange (EDI) Transactions
- Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
Provider Designations and Services Forms
- Groups, Clinics and Agencies – Physical Health
- Groups, Clinics and Agencies – Behavioral Health
- Facilities – Physical Health
- Facilities – Behavioral Health
- Practitioners – Physical Health
- Practitioners – Behavioral Health
- Long-Term Care
Facilities including Behavioral Health and Ancillary Providers
Complete the Participating Provider Interest Form for Facilities and the appropriate Provider Designations and Services Form(s) listed above.
Behavioral Health Professionals
This Professional Areas of Expertise Form is required for all behavioral health professionals and the appropriate Provider Designations and Services Form(s) listed above.
Urgent Care Centers
New Mexico Medicaid Atypical Providers
Credentialing Status Checker
To check the status of your credentialing process, enter your NPI or license number in our Credentialing Status Checker .
Case Status Checker
If you have completed a Provider Onboarding Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker .
Disclosure of Ownership and Control Interest Form
In compliance with 42 CFR 457.935, 42 CFR §455.104, $455.105, and §455.106, providers/disclosing entities are required to disclose including, but not limited to, information regarding (1) the identity of all persons with an ownership or control interest in the provider/disclosing entity, or in any subcontractor in which the provider/disclosing entity has a direct or indirect ownership of 5 percent or more including the identity of managing employees, and other disclosing entities; (2) certain business transactions and significant business transactions between the provider/disclosing entity and subcontractors/wholly owned suppliers; and (3) the identity of any person with an ownership or control interest in the provider/disclosing entity or who is an agent, or a managing employee of the provider/disclosing entity that has ever been convicted of any crime related to that person's involvement in any program under the Medicaid, Medicare, or Title XX program (Social Services Block Grants), or XXI (State Children’s Health Insurance Program) of the Social Security Act since the inception of those programs.
Any authorized/designated representative of the provider/disclosing entity may complete and sign this form on behalf of the provider/disclosing entity.
1Meeting criteria for, or completion of, one or more step(s) is not a guaranty of participation in any BCBSNM network, nor does it confer any rights upon the applicant. No communication from BCBSNM during these steps constitutes an offer capable of acceptance. Participation requires BCBSNM's counter-execution of a participation agreement, as to which BCBSNM reserves unfettered discretion to the fullest extent allowed by applicable law.
Note: A BCBSNM provider record does not automatically activate the NM network. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.
If you are interested in contracting with BCBSNM please contact us at 505-837-8800 or 1-800-567-8540.