This page may have documents that can’t be read by screen reader software. For help with these documents, please call 1-877-498-7652.

Language Assistance

Benefits
Doctors and Hospitals
Health and Wellness
Forms

open side navigation menu

Home
Benefits
- Plan Benefits
- Membership Advantage
Doctors and Hospitals
Health and Wellness
Forms

Customer Service

Questions about your coverage?

Call 1-877-498-7652 or send us a secure message through Blue Access for Members^SM.

View all contact information

Member Login

New User?
Register Now

Downloadable Forms

Medical Claim Form (Domestic)
Medical Claim Form (International)
BenefitWallet Manual Claim Form
Request for Coverage for Mentally or Physically Impaired Dependent
Coordination of Benefits Form
Standard Authorization Form and other HIPAA Privacy Forms

Legal and Privacy | Non-Discrimination Notice

Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

File is in portable document format (PDF). To view this file, 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 screen reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com

You are leaving this website/app ("site"). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.