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Sydra - NSA IDR Software

How much could properly filed federal IDR recover for your practice?

Every payment a plan makes on an out of network claim is an opening offer, and the gap between it and the amount owed is what this estimates. Enter monthly out of network claim volume and average disputed amount. Uses the published CMS win rate on the amount already in dispute. Award multiples versus QPA are not applied, which keeps this estimate deliberately conservative. Not a Sydra performance claim.

Set up a demoWhat's your claim worth?

Not ready to talk? Send one denied out-of-network EOB instead and you'll get a written IDR eligibility check and a dollar estimate back within one business day. Questions first? Email sales@sydrahealth.com.

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Billing team reviewing recovery figures on a shared monitor

Estimate

Recovery estimate tool

20
1100+
$15,000
$1,000$200,000+

Uses the CMS published 88% win rate on the amount already in dispute. Award multiples versus QPA are not applied here. Recovery is capped at the disputed amount. Not a Sydra performance claim.

Estimated annual recovery

$3,168,000

Per month

$264,000

Typical contingency cost

$633,600/yr

You keep it with Sydra.

That's $3,168,000 a year you're currently writing off.

Want that number verified against a real claim instead of an estimate? Send us one denied EOB and we'll tell you exactly what it's worth.

How this number is calculated

Estimated annual recovery = monthly eligible claims × average disputed amount × 12 × 88 percent, capped so recovery never exceeds the amount in dispute. Award multiples are measured against QPA rather than against the amount you are disputing, so this calculator applies none of them.

Published medians cluster around three to five times QPA. That is a median, not a ceiling: individual determinations land both below and well above it, and a single award can run many times higher. Nothing in that range is applied to the figure below.

The contingency comparison = that same recovery figure × 0.20, the typical contingency rate charged for out of network recovery.

88% of properly filed federal IDR disputes get paid. Source: Georgetown University CHIR, March 2026.

This estimate is deliberately conservative

We apply the published 88% provider win rate to the amount already in dispute, and we stop there. We do not apply award multiples, and recovery is capped so it can never exceed what you are disputing.

Real determinations run higher. CMS reports that the prevailing offer exceeded the qualifying payment amount in approximately 87% of payment determinations in the second half of 2025. We leave that out of the estimate on purpose — a number you can defend to your CFO is worth more than a bigger one you cannot.

What this does not account for: your specialty's award patterns, your state's dynamics, or your payer mix. For a number specific to your practice, set up a demo and we will walk through it with your actual claims.

Source: CMS, Federal IDR Supplemental Background, July–December 2025.

Want a number specific to your practice, not just the aggregate estimate?

Free 15-minute call. We look at your actual specialty, state, and payer mix.

Set up a demo

Built on Claude via Amazon Bedrock · Built to support HIPAA safeguards · BAA on request · ModMed and Stedi integrations · SOC 2 aligned, report under NDA · Security details

Related: Compare your IDR options, IDR win rates and awards.

Questions about this estimate

What does this calculator estimate?
It estimates annual recovery and the portion a typical 20 percent contingency would keep, using the published provider win rate applied to the amount already in dispute. It is an illustration for planning, not a promise for any single claim.
Are these Sydra win rates?
No. The inputs mirror the same published CMS and Georgetown CHIR figures used elsewhere on this site, and describe the federal record across every filer rather than Sydra's own results. Sydra client outcomes are published separately on the homepage, where each figure is labelled as a client result and carries the denominator behind it.
What should I do with the estimate?
Use it to compare keeping recovery in house against paying a contingency fee. Set up a demo if you want to walk through a real denied claim from your specialty and see what federal IDR would do with it.
Sourced references
  1. 1. CMS Federal IDR Q1/Q2 2025 Public Use FileReleased January 21, 2026cms.gov/nosurprises/policies-and-resources/reports
  2. 2. CMS Federal IDR Q4 2025 Public Use FileQuarter 4, 2025. Source for the per CPT area average initial payment and median figures in the Practice A table on the homepage. Geography and median denominator are pending confirmation from ops; see the TODO above PRACTICE_A in src/lib/content/homepage.ts.cms.gov/nosurprises/policies-and-resources/reports
  3. 3. Sydra client records, presented with client permissionProvenance for the Sydra performance figures in SYDRA_PERFORMANCE (src/lib/idr/proof-points.ts): 92% across 113 decided cases, 82.9% across 76 decided cases under the client's prior contingency firm, and the CPT 19318 award of $50,742.00 against a $2,500 QPA. Decided cases only; excludes withdrawn, ineligible, and pending disputes. Not federal data and not a category benchmark.
  4. 4. Georgetown University CHIR · Health Affairs webinarMarch 2026. 3.4 million disputes through June 2025; 88% win rate; median award ~4.5x in network rate
  5. 5. Zelis: NSA IDR Eligibility ChallengesMarch 2026. 44% of 2024 IDR cases challenged as ineligible by non initiating party
  6. 6. ACEP analysis of CMS data~10% of eligible claims estimated to reach IDR arbitration
  7. 7. Brookings Institution NSA Arbitration DatabookApril 2026brookings.edu/articles/no-surprises-act-arbitration-databook
  8. 8. ACR: Providers Prevail in Vast Majority of IDR ClaimsJanuary 2026. 88% of disputes found in provider's favor; 87% of awards exceeded QPA
  9. 9. No Surprises Act: Public Law 116-260, Division BB, Title I
  10. 10. Federal IDR regulations: 45 CFR Part 149ecfr.gov/current/title-45/subtitle-A/subchapter-F/part-149
  11. 11. CMS No Surprises Act overviewcms.gov/nosurprises
  12. 12. HHS HIPAA for professionalshhs.gov/hipaa/for-professionals
  13. 13. CMS Final Rule: No Surprises Act IDR overhaul (HHS, DOL, Treasury, OPM)Administrative fee reduced from $115 to $15. Batching of multiple claims now permitted to lower costs and speed resolution. New IDR Gateway centralized platform rolling out in phases.cms.gov/newsroom/press-releases/federal-rule-takes-aim-saving-taxpayer-dollars-health-care-bureaucracy-reducing-dispute-fees
Clinician and a practice advisor reviewing claim figures on a tablet in a hospital lobby

Book a demo

We'd welcome a short call to see whether this is worth pursuing. Bring one denied out of network claim and you will see what federal IDR would do with it before the call ends.

Set up a demoSee what one denied claim is worth

Or email sales@sydrahealth.com with a question.