Dtecht Provides Real Time Fraud Detection, Investigation and Prevention for Health Insurers 

Dtecht is an Australian research and development company. It has developed new software, Dtechtive®, that incorporates data mining to control and prevent billing errors and inappropriate claims. It is designed by individuals who possess extensive experience in claims processing and fraud control gained from within Australia's public and private health insurance industry.

Dtechtive® is a real-time solution compatible with electronic and manually processed claims to help the health insurance industry validate claims priot to payment of benefits. The claims are analysed in context of claim history, Dtecht's alert rules, and an insurer's rules and policy.  Any anomolies found, will generate alerts. In effect, it is like having an enormous team of people with extensive domain knowledge looking at each individual claim before it is paid and checking it for leakage (fraud and errors).

The alerts also incorporate various levels of responses to the particular problem which can include: stopping payment or requesting further information before payment. The alerts and responses can be configured by the customer so that the best return is gained from available resources.

Dtechtive® controls leakage in health insurance claims by generating alerts at the time a claim is processed. The assessment of each claim is made on the fly, so that action is taken before payment of the claim and raising awareness that insurers are diligently monitoring all claims. Dealing with berrant claims at the time of receipt will change unacceptable provider behaviour by making the provider aware of a problem.

Dtechtive® provides ease of delivery by eliminating the need for specific IT and domain expertise within the customer’s business. The health services claims data is passed through a dedicated, secure server. If an alert is generated, it is remitted to the client in real-time along with an automated action response, which has been specifically coded to the requirements of the client.

Dtechtive® is undergoing continuous enhancement.