Forms and Documents 

These commonly used forms and documents can help you manage your plan. They are available as PDF files. Just click on a form or document to download or print it. You may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe^® Reader^® which has a built-in reader. You can download this at Adobe's site.

Member Plan Documents

Member Handbook

Provider Network Directory

Value-Added Services

Prescription Drug Forms and Documents

Preferred Drug List

Preferred Drug List Updates

Pharmacy Directory

Medicaid Prescription Drug Claim Form – Complete this form to submit a claim for a prescription. You must submit the original pharmacy receipt with the form.

Medicaid Prescription Mail-Order Form – Use this form to mail order new or refill prescription maintenance medicines. Mail the completed form to the address on the form. You must include the original prescription signed by your doctor.

Medicaid Rx Mail-Order Flier – Learn how to order the medicines that you take long-term or every day. You can have them delivered to your home.

Patient Medication List Form – Keep a record of your medications on hand to share with your doctor. 

Transportation Forms and Documents

Legal and Privacy Forms

Member Appeal Request Form – You or your appointed representative may use this form to file an appeal. Please review the instructions on the form to learn how to file an appeal.

Provider Appeal Request Form – You can have your provider submit an appeal for you. Use this form and please follow the instructions. Your provider will need to include certain information to support the request. Also, you must sign the form. Once completed, send it to the address shown on the form.

Power of Attorney Form – Have someone you trust to make health care decisions if you are unable to do so. Follow instructions on the form.

Standard Authorization Form and other Privacy Forms

Other Forms and Documents

Primary Care Provider Selection Form – Turquoise Care members must select a PCP. Fill in your PCP's information and mail the completed form to BCBSNM.

Blue for Your Health Newsletters

Health Education Events for Turquoise Care Members

Preventive Care Guidelines for Adults

Preventive Care Guidelines for Children