Sydra is an AI-powered platform for the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process. It automates eligibility screening, evidence packaging, offer preparation, submission, and deadline tracking so providers, contingency firms, and RCM companies recover fair out-of-network payments.

Healthcare providers and provider groups, contingency firms pursuing out-of-network disputes, and revenue cycle management (RCM) companies that add NSA IDR to their services.

Do you file disputes for us, or is it self-service?

Both. Sydra offers full-service filing (we file for you), self-service (your team files with the software), or staff training. You can switch models at any time.

How much does Sydra cost?

Sydra is a flat, predictable fee — less than half of what most contingency firms charge (which typically take 20% or more of every recovery, indefinitely) — or you can license the software and run it yourself.

Is Sydra HIPAA compliant?

Yes. Protected health information is handled under a Business Associate Agreement (BAA).

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No Surprises Act · New Hampshire

Out-of-network claims in New Hampshire — that payment is an opening offer

Dispute pathway: Federal IDR + state pathway

Out-of-network surgical and hospital-based claims in New Hampshire are routinely paid below the billed charge or denied outright. Under the No Surprises Act that payment is an opening offer, and dispute resolution exists to contest it. Sydra checks what qualifies, assembles the submission, holds every deadline, and can file it for you.

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How disputes route in New Hampshire

Federal IDR + state pathway

New Hampshire runs a baseball-style Independent Dispute Resolution process aligned with the federal No Surprises Act (SB 173, effective January 1, 2025; RSA 358-T, replacing the earlier RSA 329:31-b balance-billing law). A 30-day negotiation precedes a certified IDR entity.

State-regulated plans follow New Hampshire's IDR. Self-funded ERISA plans follow the federal IDR process. Confirm routing by plan type before filing.

What's specific to New Hampshire

The 2025 law replaced a 'commercially reasonable rate' set by the Insurance Commissioner with final-offer IDR harmonized to the federal process.
Covers emergency services and any service at an in-network facility, including ancillary anesthesiology, radiology, and pathology.

There is a defined pathway between a payer's underpayment and a binding arbitrated amount — an open negotiation window, an eligibility determination, a batching decision, then arbitration. Each step has a hard deadline, and missing one forfeits the claim. Providers win roughly 88% of federal IDR determinations they contest. Sydra is a flat, predictable fee — less than half of what most contingency firms charge. We file it, you keep the recovery.

Browse by specialty

Spine surgery Orthopedic surgery Neurosurgery Plastic and reconstructive surgery Interventional pain Hand surgery Emergency medicine Radiology Pathology Anesthesia Podiatry Neonatology Assistant Surgeons Ophthalmologic Surgeons Hospitalists Intensivists Physician Assistants

Commonly disputed procedures in New Hampshire

Anterior cervical discectomy and fusion, single level (CPT 22551)Anterior cervical fusion, each additional level (CPT 22552)Cervical or thoracic epidural injection with imaging (CPT 62321)Lumbar or sacral epidural injection with imaging (CPT 62323)Total hip replacement (CPT 27130)Partial hip replacement (hemiarthroplasty) (CPT 27125)Craniotomy for brain tumor removal, supratentorial (CPT 61510)Craniotomy for meningioma removal, supratentorial (CPT 61512)Muscle flap, trunk (CPT 15734)Muscle flap, lower extremity (CPT 15738)Wrist joint replacement (interposition arthroplasty) (CPT 25447)Flexor tendon repair in zone 2, single (CPT 26356)Emergency department visit, minor (CPT 99281)Emergency department visit, low complexity (CPT 99282)CT scan of the head, without contrast (CPT 70450)CT scan of the head, with contrast (CPT 70460)Tissue exam under the microscope, level IV (CPT 88305)Tissue exam under the microscope, level III (CPT 88304)Epidural anesthesia for labor and delivery (CPT 01967)Anesthesia for upper abdominal surgery (CPT 00790)Correction, hammertoe (CPT 28285)Capsulotomy; midfoot (CPT 28270)Initial neonatal critical care, 28 days or younger (CPT 99468)Subsequent neonatal critical care, 28 days or younger (CPT 99469)Cataract removal with intraocular lens (CPT 66984)Intravitreal injection of a pharmacologic agent (CPT 67028)Initial hospital inpatient care, high complexity (CPT 99223)Subsequent hospital inpatient care, high complexity (CPT 99233)Central venous catheter insertion, age 5 or older (CPT 36556)Arterial catheterization for monitoring (CPT 36620)Coronary artery bypass, single arterial graft (CPT 33533)Laparoscopic cholecystectomy (CPT 47562)Incision and drainage of abscess, simple (CPT 10060)Debridement, subcutaneous tissue (CPT 11042)

Return to the Federal IDR hub.

No outcome is guaranteed. Results vary by claim, payer, specialty, and documentation. State routing depends on plan type; confirm against the CMS applicability chart before filing. This is general information, not legal or financial advice.

Medically & clinically reviewed by Dr. John M. Abrahams, MD

Board-certified neurosurgeon and founder of Sydra · Last reviewed September 2026 · About the author

Sources

Figures reflect the published federal record across all disputes, not a prediction about any individual claim. This is general information, not legal or financial advice.