PSHP-GA-Facility Agency Change Form Facility Agency Change Form 2026

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  1. Click ‘Get Form’ to open the PSHP-GA-Facility Agency Change Form in the editor.
  2. Begin with SECTION A, where you will input essential information such as today's date, effective date of change, facility/agency name, and contact details. Ensure accuracy to avoid processing delays.
  3. Proceed to SECTION B if you need to change location information. Depending on your needs (delete, update, or add a location), complete the relevant subsections (Ia, Ib, Ic).
  4. If applicable, fill out SECTION C for accreditation and licensing details. Attach any necessary documents as indicated.
  5. For billing address changes, navigate to SECTION D and provide the new billing address along with an updated W-9 if required.
  6. Complete SECTION E if you are changing taxonomy information. Ensure that all fields are filled accurately.
  7. Finally, review all sections for completeness before submitting your form electronically through our platform for efficient processing.

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Upload your PSHP-GA-Facility Agency Change Form Facility Agency Change Form to DocHub (once you’ve set up an account for this). If you need to complete fields in it, use appropriate tools from the top pane. For instance, add Signature Fields, assign each to a particular person, and click on Sign → Request signatures from others. Personalize your message for your recipients and click Send Request. You can also send your form by fax or as a Signing link instead of using email (you’ll locate these options by navigating to the Menu → Send)

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Consumers can enroll in or change coverage through the Georgia Access consumer portal, or with a certified agent, web broker, or insurance company.
Peach State Health Plan (Peach State) is a health plan participating in Georgia Families (GF). It is a managed care program for Medicaid and PeachCare for Kids members. We offer our members local healthcare programs and services.
Centene, CVS Health, Elevance, Molina, and UnitedHealth are the five largest publicly traded companies (also referred to as parent firms) operating Medicaid MCOs, accounting for half of Medicaid MCO enrollment nationally.

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You can change your health plan in one of these three ways: Online: Go to Log In or Register link and follow the steps. By phone at 1-888-GA-Enroll (1-888-423-6765) Call Monday to. Friday, 7 a.m. to 7 p.m. On paper, using a form you get in the mail from Georgia Families.
You can enroll in a different plan during Open Enrollment. Log into your Marketplace account and update your application. Then, enroll in a plan that meets your needs. Enroll by December 15 in a new plan of your choice, for coverage to start January 1.
You can report a change: Online at gateway.ga.gov. In-person at your local Division of Family Children Services (DFCS) office. By mail to your local DFCS office. By phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.

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