A Multi-Provider Psychiatry Group Switched to Valant and Lost $164,000 in the First 6 Months. The EHR Migration Was Incomplete.
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THE SITUATION
This group practice migrated from Kareo to Valant in January 2024. The migration was completed on schedule and on budget in 6 weeks. By June 2024, revenue was down 22% compared to the same period in 2023.
The practice manager assumed it was a patient volume issue. It wasn’t. Volume was actually up 8%. The migration had moved patient demographics and appointment data.
It had not migrated 7 payer-specific billing configurations that existed in Kareo because Valant handles those configurations differently, and no one had rebuilt them.
WHAT WAS ACTUALLY WRONG
Premera BCBS WA requires an NPI at the rendering provider level; Valant was submitting only the billing NPI:
Premera Washington requires the rendering provider’s individual NPI in box 24J of the CMS-1500. Valant’s default submits the group billing NPI. Every Premera claim was processed under the group NPI with no rendering provider identification, triggering reduced reimbursement or denial depending on the service.
Apple Health (WA Medicaid) requires Taxonomy Code 193200000X for group practice billing:
Apple Health’s provider taxonomy requirement for behavioral health group practices differs from standard NPI submission. Valant wasn’t including taxonomy on Apple Health claims; every Apple Health claim was returning a provider not identified rejection.
Psychiatrists’ E/M and psychotherapy code combinations weren’t configured for Regence:
Regence BCBS has specific modifier requirements for same-day E/M and psychotherapy services (99213 + 90833). The Kareo configuration handled this automatically. Valant requires manual modifier setup per provider per payer. The setup wasn’t done; claims were being submitted without modifiers and were being denied or downgraded.
WHAT WE DID
Week 1: Conducted a full payer-by-payer configuration audit in Valant. Documented all 7 gaps versus prior Kareo setup.
Week 2: Configured rendering provider NPI submission for Premera at the claim level. Rebuilt Apple Health taxonomy requirement. Set up E/M + psychotherapy modifier rules for each psychiatrist for Regence.
Weeks 3–4: Completed the remaining 4 configuration fixes: UHC timely filing alerts, Premera therapy code fee schedule alignment, group vs individual session logic, and Apple Health billing unit configuration.
Weeks 5–16: Resubmitted 6 months of misconfigured claims with corrections. Premera accepted corrected NPI submissions retroactively. Apple Health processed corrected taxonomy claims within 30 days.
THE RESULTS
| Metric | Before | After |
|---|---|---|
| Revenue Lost (migration gap) | $164,000 | N/A |
| Revenue Recovered | — | $138,000 |
| Configuration Gaps | 7 active | 0 |
| Apple Health Rejection Rate | 100% | 4% |
| Premera Rendering NPI Compliance | 0% | 100% |
WHAT THIS MEANS FOR YOUR PRACTICE
EHR migrations are billing risk events. Every payer‑specific configuration must be rebuilt in the new system, and “IT‑complete” migrations can miss 30% of billing‑critical setup. If you’ve switched EHRs in the last 12 months and revenue is soft, start by reviewing the migration.