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).

Which specialty has the highest IDR win rate?

Radiology has the highest provider win rate in the 2025 CMS Federal IDR data at about 92%, followed by hospitals and facilities (~87%). Orthopedic surgery is the lowest of the major specialties shown at about 81.5%, and anesthesia is about 83%.

What is the IDR win rate for emergency medicine?

Providers win about 85% of federal IDR determinations in emergency medicine — the single largest category, with roughly 3.35 million decided line items in the 2025 CMS Federal IDR Public Use Files.

Do surgeons win federal IDR disputes?

Yes. In the 2025 CMS Federal IDR data, neurosurgery providers win about 86% of determinations and orthopedic surgery about 81.5%. Surgical out-of-network claims rarely lose on the merits — the losses are usually process failures (deadlines, offer justification), not the strength of the claim.

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Data & benchmarks

Federal IDR win rates by specialty

How often providers win out-of-network disputes under the No Surprises Act, broken down by specialty. Computed from the CMS Federal IDR Public Use Files for 2025, weighted by decided line items.

~92%

radiology — the highest specialty

3.35M

emergency-medicine line items — the largest

80%+

win rate in every major specialty

Provider win rate by specialty

Specialty	Win rate	Decided line items	Notes
Radiology	92.2%	~936,000	Highest win rate of any major specialty.
Hospitals & facilities	87.1%	~577,000	Facility and observation claims.
Plastic & reconstructive surgery	86.9%	~29,000	Reconstructive and microsurgery claims.
Pain management	86.8%	~50,000	Interventional pain procedures.
Intraoperative neuromonitoring	86.7%	~197,000	IONM during surgery — the patient never chose the provider.
Neurosurgery	85.7%	~10,000	Cranial and spine surgical claims.
Emergency medicine	85.2%	~3,348,000	By far the largest volume — the archetypal NSA claim.
Anesthesia	83.1%	~276,000	Base-plus-time billing; below the average.
Orthopedic surgery	81.5%	~6,800	Lowest of the specialties shown.

CMS Federal IDR Public Use Files, calendar year 2025; win rate = provider-prevailing line items ÷ decided line items, grouped by specialty and weighted by volume. Figures rounded. Individual practices vary widely — many self-filing groups win well below these averages.

What the specialty data shows

Every major specialty wins 80%+. From radiology (~92%) to orthopedics (~81.5%), providers prevail in the large majority of contested determinations.
Emergency medicine dominates the volume. At ~3.35 million decided line items, it is larger than every other specialty combined — the archetypal No Surprises Act claim.
Losses are process, not merits. Even surgical specialties that "should" win — neurosurgery, orthopedics — leave money on the table when deadlines slip or the offer isn't justified, not because the claim was weak.

Where does your specialty stand?

These are national averages. Sydra shows you your win and default rates by payer and CPT from the same CMS data — and closes the gap for a flat fee.

Win rates by payer →

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.