Loading
Get Ga Pshp Facility/agency Change Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the GA PSHP Facility/Agency Change Form online
This guide provides step-by-step instructions for completing the GA PSHP Facility/Agency Change Form online. Whether you need to update contact information or change billing addresses, following this guide will ensure that your submission is efficient and accurate.
Follow the steps to accurately submit your facility or agency changes online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Identify the specific change you wish to make. Various options include changing an address, adding a new location, or updating billing information.
- Complete SECTION A, which requires basic information such as today's date, effective date of change, facility/agency name, and contact details.
- Depending on your change type, fill out the corresponding sections. For a change of primary address, complete SECTION B, or for billing address changes, complete SECTION D.
- If applicable, provide additional information in ATTACHMENT F to specify changes affecting particular practitioners.
- Review all completed sections for accuracy before finalizing your form.
- Once satisfied with the information provided, you may save changes, download, print, or share the form as necessary.
Begin completing the GA PSHP Facility/Agency Change Form online today for seamless processing of your updates.
Call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056). You can also view more information about Peach State Health Plan in our Member Handbook.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.