Federal IDR · No Surprises Act
That payment is an opening offer.
Most practices treat a payer's out-of-network payment as the amount owed. Under the No Surprises Act it isn't — federal IDR exists to contest it.
You run a practice
- 88%
- of properly filed federal IDR disputes get paid
- 5 min
- to prepare a complete submission packet
- Or we file it
- our team handles every dispute end to end
- June 2026
- built for the current federal IDR rules
IDR is a process problem, not a legal mystery.
The rules and the deadlines are fixed. That is exactly what makes the work automatable.
Never filed IDR?
We identify which claims qualify, assemble submissions, and manage every deadline without changing how you practice or bill.
Book a demo
We'd welcome a short call to see if this is worth pursuing.
Already using a contingency firm?
Sydra runs per-claim/subscription pricing instead of a percentage of recovery, so costs stop scaling against you as your volume grows.
Book a demo
We'd welcome a short call to see if this is worth pursuing.
Run an RCM company?
IDR is still mostly manual work. Sydra supplies the automation layer so you can add or expand an IDR service line without scaling headcount, white-label available.
See Sydra at billing company volume
Book a demo
We'd welcome a short call to see if this is worth pursuing.
Run a contingency firm?
Same engine, aimed at recoveries per FTE — automating the mechanical steps makes smaller claims worth pursuing and frees your team for the disputes where judgment matters.
Book a demo
We'd welcome a short call to see if this is worth pursuing.
What this looks like in practice
Two anonymized examples from Sydra's book of business. The first shows the gap between what payers initially pay and what federal IDR can award. The second compares Sydra's outcomes against the contingency firm the practice used previously.
Practice A — plastic & reconstructive surgery
Source: 2025 Public Use File (PUF) data, Quarter 4
| CPT Code | Description | Area Avg Initial Payment | Median | Case Example |
|---|---|---|---|---|
| 19318 | Breast reduction | $2,031.61 | $1,479.26 | QPA $2,500 → award $50,742.00 (20.30x QPA)1 |
| 15734 | Muscle/myocutaneous flap | $2,623.45 | $968.18 | — |
| 19357 | Breast reconstruction (tissue expander) | $2,048.21 | $1,863.53 | — |
| 19364 | Free flap breast reconstruction | $3,116.33 | $747.71 | — |
1 Single case. Not a typical or expected result.
Practice B — established IDR filer, switched from a contingency firm
The 88% figure above is the federal record across every filer in the CMS dataset (Georgetown University CHIR, March 2026). The rate below is one Sydra client's own outcome across its decided cases. They measure different things and neither predicts the other.
| Metric | Sydra | Prior Contingency Firm |
|---|---|---|
| Decided cases | 113 | 76 |
| Win rate | 92% | 82.9% |
| Loss rate | 8% | 17.1% |
| Fee structure | Per-claim / subscription | 20% contingency |
Disclaimer: The figures above reflect actual outcomes for specific Sydra clients and are presented with client permission. Practice names and identifying details have been removed. Payment averages and medians are derived from the 2025 federal Independent Dispute Resolution Public Use File (PUF), Quarter 4, and reflect reported activity for the referenced procedure codes in the applicable geographic region; they are not Sydra performance figures. Individual case examples are single outcomes and are not typical, average, or expected results. Win rates reflect decided cases only for the referenced client over the period measured and do not include withdrawn, ineligible, or pending disputes. Past results do not guarantee or predict future outcomes. Eligibility for federal IDR, applicable deadlines, and award amounts depend on the specific facts of each claim, the applicable plan, and current federal regulations, which are subject to change. Nothing on this page is legal, financial, billing, or coding advice. Sydra is not a law firm and does not provide legal representation.
FAQ
Common questions
What's Sydra and who is it for?
Sydra is AI software for federal IDR and NSA dispute resolution, built for surgical billing teams at orthopedic, neurosurgery, spine, and plastic surgery practices. Your billing team operates the software in house, reducing IDR claim preparation from 25 to 40 minutes to about five minutes per claim, or Sydra prepares and files every dispute for you. Sydra runs on AWS Bedrock with HIPAA controls and BAA available.
How does Sydra reduce IDR prep time?
Sydra uses Claude Sonnet 4 on AWS Bedrock to generate a complete federal IDR submission packet from an uploaded EOB. The system drafts the executive summary, market rate justification citing prior IDR determinations, and clinical necessity narrative from your operative note. Your billing team reviews, approves, and exports a submission ready DOCX file with a guided checklist for the federal IDRE portal.
How does Sydra compare to a typical contingency?
A typical contingency takes 20% of every IDR recovery. Sydra is software your billing team operates, priced below that rate with an exact quote on the demo call. You keep the recovery instead of losing 20% per award. Sydra defaults to one claim per CPT to protect win rate, while batching remains available under the 2026 CMS rule when your team chooses it per submission.
Is Sydra HIPAA compliant?
Yes. Sydra runs on AWS healthcare workloads with HIPAA eligible Claude Sonnet 4 on AWS Bedrock. A Business Associate Agreement is available for covered entities. Documents are encrypted in transit and at rest. Strict per practice tenant isolation is enforced at every database table. PHI never leaves the AWS HIPAA eligible service boundary during AI generation.
What's the difference between Sydra Self Serve, Sydra plus Support, and Sydra Full Service?
Sydra Self Serve is software your billing team operates independently. Sydra plus Support adds live specialist support, monthly account reviews, and escalation on edge cases. Sydra Full Service is fully outsourced: our team handles every claim end to end. Start with a free claim review at /case-review. The right fit depends on who operates the workflow, not claim volume alone.
Book a demo
We'd welcome a short call to see if this is worth pursuing.