Transcription of PARTICIPATING PROVIDER INTEREST FORM …
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PARTICIPATING PROVIDER INTEREST FORM …
Box 27630 Albuquerque, New Mexico 87125-7630 1-800-835-8699 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Rev 11/01/2015 PARTICIPATING PROVIDER INTEREST FORM FACILITY/AGENCY/VENDOR The attached packet contains the forms required in order to be considered for network participation with Blue Cross Blue Shield of New Mexico (BCBSNM). Please complete all applicable sections of the packet and return to NM Network Services by fax (preferred method) or by mail as indicated below.
Mental Health Substance Abuse Detoxification Eating Disorder Adolescent ; Mental Health Substance Abuse Detoxification Eating Disorder
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