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 · Washington

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

Dispute pathway: Federal IDR + state pathway

Out-of-network surgical and hospital-based claims in Washington 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 Washington

Federal IDR + state pathway

Washington runs baseball-style arbitration for out-of-network payment disputes, with the carrier first paying a 'commercially reasonable amount' (Balance Billing Protection Act, 2019; RCW 48.49). A 2022 amendment (HB 1688) aligned the law with the federal No Surprises Act, so many services now route to federal IDR.

State-regulated plans follow Washington's process, and self-funded plans may opt in; since 2023 most federally covered services route to the federal IDR process. Confirm routing by plan type before filing.

What's specific to Washington

Final-offer arbitration weighs the state balance-billing data set of median contracted rates; up to 20 similar claims can be batched per filing.
After HB 1688, state arbitration principally governs air ambulance and matters outside federal scope, with most services on federal IDR.

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 Washington

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.