Pshp form 2026

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Click ‘Get Form’ to open the pshp form in the editor.
Begin by entering the date at the top of the form. Ensure it is clear and legible.
Fill in the MEMBER INFORMATION section, including your name, date of birth, and member ID number.
Next, complete the PROVIDER INFORMATION section with your provider's name, tax ID number, and contact details.
In the CURRENT ICD DIAGNOSIS section, provide primary, secondary, and tertiary diagnoses as applicable.
Answer the FUNCTIONAL OUTCOMES questions based on recent experiences over the last 30 days. This section requires thoughtful responses.
Indicate any SYMPTOMS present and their severity by checking the appropriate boxes.
Complete the RISK ASSESSMENT section by selecting options that reflect current safety concerns.
Finally, review all entries for accuracy before submitting your completed form to ensure a smooth processing experience.

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Will postal retirees be forced into Medicare?

As required by the Postal Service Reform Act of 2022 (PSRA), certain Medicare-eligible Postal Service annuitants and their Medicare-eligible family members must enroll in Medicare Part B to remain enrolled in a PSHB plan. There are some exceptions to this requirement.

What is the PA request form?

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.

Are Peach State and Medicaid the same thing?

Visit our Provider Portal at for the most current Prior Authorization Guide and authorization forms. Should you have any questions, please contact Provider Services at 713.295-2295 (Medicaid/CHIP), 713.295-6704 (Marketplace) or 713.295. 5007 (HMO D-SNP).

What is a PSHP?

A prior authorization (PA) review is used for a wide variety of medications to confirm that medication is being prescribed for its intended use based on FDA guidelines. These reviews are meant to ensure certain prescriptions meet specific criteria before they are covered by a pharmacy plan.

What is the downside to a PPO plan?

PSHB is supposed to be cheaper than the current FEHB plans and, when combined with Medicare Part B, may save annuitants money.