How Sydra prepares a federal IDR submission.Step by step, element by element.

Element 1 — Payment offer

Claude, the AI built by Anthropic and run via Amazon Bedrock, identifies the correct CPT code from the EOB, and Sydra prepares the formal offer statement. One claim per CPT. If the EOB contains multiple CPT codes, Sydra generates a separate submission packet for each. Never batched. Your billing team reviews every decision before anything is filed.

The one CPT per claim structure isn't configurable. It's how federal IDR was designed, and it's what the data shows produces the best outcomes for providers.

Element 2 — Market rate justification

Sydra pulls prior IDR determinations from its library of 213+ ingested cases, filtered to your specific CPT code and your state. The market rate section cites those determinations directly with case identifiers and determination amounts.

Element 3 — Clinical necessity narrative

Upload the operative note as a PDF. Claude via Amazon Bedrock reads the document directly through its multimodal layer. No OCR. No copy paste. The PDF is processed directly.

Sydra extracts: the procedure performed, surgical approach, clinical indication, surgeon's documentation of complexity, intraoperative findings relevant to clinical justification, and technique specific details that distinguish this case from a templated submission.

The narrative draft is built from those extracted elements, not from a template. Your billing team reviews. If something in the operative note strengthens the clinical argument, Sydra surfaces it. If the biller sees something that needs adjustment, they edit it. The draft is a starting point. The human is still the reviewer.

Element 4 — Provider credentials

Sydra maintains a provider profile built from the surgeon's CV. Upload the CV once as a DOCX. Sydra extracts: board certifications, fellowship training, procedure volume by CPT category, publications, and practice affiliations.

Each submission automatically includes the credential block relevant to the CPT being filed. A craniotomy submission includes the surgeon's neurosurgical training and cranial procedure volume. A total knee submission includes orthopedic training and arthroplasty volume.

Element 5 — Open negotiation documentation

If you have sent an Open Negotiation Notice, upload it. Sydra attaches it with the required proof of delivery fields populated. If you haven't yet sent it, Sydra flags this before generating the submission. IDR can't be initiated without completing the open negotiation step.

Element 6 — Eligibility verification

At EOB upload, Sydra runs a real time eligibility check through the Stedi clearinghouse (270/271 transaction) if the practice is connected to ModMed. For manual uploads, Sydra reviews the claim data against federal eligibility criteria and flags any concerns.

Any eligibility flag is surfaced before the draft is generated. You resolve the flag or you don't file the claim. The system prevents ineligible submissions from being prepared.