School-Based Medicaid Program - Guidance to Resolve 047 Claims Denials (IB 26-5)
Date: 02/19/26
Louisiana Healthcare Connections is sharing with providers School-Based Medicaid Program - Guidance to Resolve 047 Claims Denials (IB 26-5) published on February 19, 2026.
Attention Local Educational Agency (LEA) Providers: Louisiana Medicaid is providing guidance to address and resolve 047 claim denials (invalid or missing ordering provider) caused by incomplete or inaccurate ordering/prescribing /referring (OPR) provider information on School Based Medicaid Program (SBMP) claims.
Common Reasons for 047 Claim Denials
- The OPR National Provider Identifier (NPI) is incorrect or missing. (For a list of procedure codes that are excluded from requiring an OPR, see Informational Bulletin 24-47.)
- OPR NPI is not active or eligible on the date of service (DOS).
- OPR provider is not authorized to order, prescribe, or refer.
- OPR NPI has multiple Medicaid IDs, and an NPI tiebreaker (taxonomy) must be submitted. See section below, “NPI Tiebreaker Taxonomy (Required).”
The following information aligns with federal regulations, which require states to enroll all Medicaid providers that order, prescribe, or refer items or services for Medicaid beneficiaries, even when the provider does not submit claims to Medicaid.
- Medicaid Enrollment: LEA Licensed Professionals with OPR Authority
- Providers employed or contracted with LEAs servicing Medicaid beneficiaries who are not enrolled in fee-for-service Medicaid must enroll as provider type (PT) PO-OPR in order to ensure reimbursement for services rendered.
- This now includes audiologists and occupational therapists.
- See the OPR Enrollment Packet (application)
- Licensed professionals are authorized to practice only to the extent permitted by their license and subject to all applicable terms and conditions.
- Providers employed or contracted with LEAs servicing Medicaid beneficiaries who are not enrolled in fee-for-service Medicaid must enroll as provider type (PT) PO-OPR in order to ensure reimbursement for services rendered.
- NPI Tiebreaker Taxnomy Requirements
- When a single NPI is linked to multiple Medicaid provider numbers, a “tiebreaker” must be used to distinguish which Medicaid number is being referenced.
- For example, EarlySteps providers enrolled as PT 29 and PT PO (OPR) will have to submit the taxonomy tiebreaker 251300000X when submitting as the referring, prescribing or ordering provider on SBMP claims.
- A separate NPI tiebreaker must be obtained and submitted with each Louisiana Medicaid provider number.
- The required taxonomy code for the SBMP is: 251300000X
- To obtain an NPI tiebreaker for your other Louisiana Medicaid provider number(s), see the Health Care Provider Taxonomy code set .
- Once a taxonomy is obtained for each Louisiana Medicaid provider number, fill out the SBMP - NPI Tiebreaker Form and fax the signed form to (225) 216-6392 or email it to louisianaprovenroll@gainwelltechnologies.com.
- If the NPI taxonomy code does not match what has been set up based on the SBMP - NPI Tiebreaker Registration Form, claims will be denied with error code 047 - invalid or missing ordering provider.
- When a single NPI is linked to multiple Medicaid provider numbers, a “tiebreaker” must be used to distinguish which Medicaid number is being referenced.
Service Exceptions to the NPI Billing Requirements
Please see Informational Bulletin 24-47 for procedure codes that may be submitted without the referring, ordering, or prescribing provider’s NPI for SBMP claims.
For assistance with enrollment/verification of fee-for-service enrollment status, contact Gainwell Technologies at (833) 641-2140 or by email at louisianaprovenroll@gainwelltechnologies.com.
General questions related to billing should be directed to Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040 and by email at providerrelations@la.gov.