Summaries of Active Nautilus Projects
These Projects are currently active in Nautilus. This means that project panels, standards, and enabling resources already exist or are being actively developed or built. Head to the Nautilus home page to see other projects that aren’t active yet, but are being scoped. If there is a Nautilus project that doesn’t exist, but that you think should exist, please reach out to us.
TPA Procurement, Contracting, and Management
Data Access & Utilization
Advisor Procurement, Contracting & Management
PBM Procurement, Contracting & Management
Project Panel Status: Actively adding Organizers, Experts, and Evangelists to the existing Project Launch Panel. The project is recruiting top notch experts in areas like claims adjudication, banking & flow of funds, TPA operations, account management, experienced advisors & their account managers, claims system experts, and more.
Standards of Excellence Status: Contract Criteria and Claims Data Feed Criteria are currently in development. Other criteria related to operational capabilities, expected RFP responses, RFP scoring, and more will be developed once the full project panel is finalized.
Current Supporting Resources
TPA Procurement, Contracting & Management Field Guide - This is a comprehensive document that includes summaries of major issues, FAQs, best practices, issues to focus on, and more. A few of the primary resources included in this field guide include:
Template RFP questions and other supporting documents
Template Administrative Services Agreement (ASA)
ASA review checklist, template clauses, common pitfalls, etc.
Project Panel Status: Actively adding Organizers, Experts, and Evangelists to the core Project Launch Panel. The project is recruiting experts in software development, claims analysis, data science/analysis, and technical skills.
Standards of Excellence Status: Claims and Eligibility Data Feed Criteria are currently in development. Other criteria will be developed once the full Project Panel is finalized.
Currently Available Enabling Resources
METL Open Data Platform Codebase. METL is an open source data ingestion, warehouse, and interchange platform. It is currently in closed beta for approved software developers and data scientists looking to more quickly and cost effectively build data-centric tools and services. Request access to the closed beta here.
The Data Access and Use section of the TPA project’s Field Guide includes resources to help plans and their advisors gain access to and use plan claims data, including data demand letters, descriptions of standard reports to expect, etc.
Project Panel Status: Actively adding Organizers, Experts, and Evangelists to the core Project Launch Panel. The project is recruiting experts in benefits advising, such as experienced advisors, account managers, HR leaders, actuaries, and more.
Standards of Excellence Status: Criteria are currently in development and will be finalized once the full Project Panel is finalized.
Currently Available Enabling Resources
Advisor Selection RFP Questions
Project Panel Status: Actively adding Organizers, Experts, and Evangelists to the core Project Launch Panel. The project is recruiting top notch experts in Rx claims adjudication, PBM operations, PBM Consulting, contracting, account management, claims system experts, and more.
Standards of Excellence Status: Criteria will be developed once the full Project Panel is finalized.
Current Enabling Resources
Initial PBM Procurement, Contracting & Management Field Guide is currently in development, which will include template contracts, RFP materials, and more.