Online Panel Help Print
Contact Information
The contact information panel provides users with the ability to contact Georgia Medicaid through the public and secure Web Portal. Users authenticated as a provider, member or trading partner will continue to have access to the page, which includes additional items in the selection list. The appearance of the panel changes based on the Select an Item and Contact Method drop-down fields selected.

Navigation Path: [Contact Information] - [Contact Us]

Field Descriptions:
FieldDescription
cancelThis button cancels the current operation and discards any data.
submitThis button saves and submits the request.
top of pageThis button jumps the user to the top of the page.
Address Line 1Displays the first line of the address for the contact when the contact method is mail.
Address Line 2Displays the second line of the address for the contact when the contact method is mail.
Attention ToDisplays the attention to line of the address for the contact when the contact method is mail.
CityDisplays the city of the address for the contact when the contact method is mail.
Confirm EmailDisplays the retyping of the email address for the contact when the contact method is email.
Contact MethodDisplays the method the contact wishes to be contacted by.
Describe the problem you encounteredDisplays the description of the problem that the contact encountered when the selected item is having technical problems.
Email AddressDisplays the email address for the contact when the contact method is email.
Fax NumberDisplays the fax number for the contact when the contact method is fax.
How can we help you?Displays the free form text for the help that the contact needs when the selected item is not a technical problem.
Last Name, First NameDisplays the first and last name for the contact when the contact method is telephone, fax, or email.
Phone NumberDisplays the phone number and extension for the contact when the contact method is telephone.
Select an ItemDisplays the reason the user is contacting Georgia Medicaid.
State, Zip CodeDisplays the state, zip code, and zip code extension of the address for the contact when the contact method is mail.
FieldError MessageTo Correct
Address Line 1 Address Line 1 is required.Enter an Address Line 1 when Contact Method is Mail.
Attention To Attention To is required.Enter an Attention To when Contact Method is Mail.
City City is required.Enter a City when Contact Method is Mail.
Confirm Email Confirm EMail is required.Enter an E-mail address when Contact Method is E-mail.
Describe the problem you encountered Describe the problem you encountered is required.This field must be completed.
Email Address EMail Address is required.Enter an E-mail address when Contact Method is E-mail.
The Email and Confirm Email must contain the same value.Enter a valid e-mail and confirm e-mail address
Fax Number Fax Number is required.Enter a Fax Number when Contact Method is Fax.
How can we help you? How can we help you? is required.This field must be completed.
Last Name, First Name First Name is required.Enter a contact First and Last Name when Contact Method is Telephone, E-Mail, or Fax.
Last Name is required.Enter a contact First and Last Name when Contact Method is Telephone, E-Mail, or Fax.
Phone Number Phone Number is required.Enter a valid phone number.
Select an Item Select an Item is required.Select an item from the list.
State, Zip Code State is required.Select a State when Contact Method is Mail.
Zip is required.Enter a Zip when Contact Method is Mail.