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  • Ga Pshp Facility/agency Change Form

Get Ga Pshp Facility/agency Change Form

FACILITY/AGENCY CHANGE FORM Submit one Facility/Agency Change Form (FCF) per TIN. Do not submit changes for multiple TINs on FCF. The preferred method for completing the FCF is electronically. Hand.

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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.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Identify the specific change you wish to make. Various options include changing an address, adding a new location, or updating billing information.
  3. Complete SECTION A, which requires basic information such as today's date, effective date of change, facility/agency name, and contact details.
  4. 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.
  5. If applicable, provide additional information in ATTACHMENT F to specify changes affecting particular practitioners.
  6. Review all completed sections for accuracy before finalizing your form.
  7. 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.

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Contact support

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.

Q. Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.

Peach State Health Plan (Peach State) is a physician-driven, Georgia-based Medicaid managed care plan. Backed by our parent company, Centene Corporation®, Peach State draws on financial stability and national expertise to deliver local services and programs.

For more than 20 years, Centene has provided comprehensive managed care services to the Medicaid population and currently operates health plans in Arizona, Arkansas, California, Florida, Georgia, Florida, Illinois, Indiana, Kansas, Louisiana, Massachusetts, Mississippi, Missouri, New Hampshire,, Ohio, South Carolina, ...

Timely Filing Requirements: All claims must be received by the plan within six (6) months from the date the service was provided in order to be considered for payment. Claims received after this time frame will be denied for failure to file timely.

Medicaid vs. PeachCare for Kids: The main difference between Medicaid and PeachCare for Kids is the income level. PeachCare for Kids serves working families whose income is more than that set by the Medicaid Program.

There are four (4) ways to change a CMO selection during the Choice Change Period: Online: Go to .georgia-families.com. By Phone: Call 1-888-GA-ENROLL (1-888-423-6765). By Fax: Fax the Enrollment Form to 1-866-4U2ENROLL (1-866-482-3676). By Mail: Mail the Enrollment Form to the following address:

Peach State Health Plan provides the same benefits as Medicaid, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services Peach State Health Plan offers. Need help understanding these benefits and services? Call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056).

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