By December 31, 2025: (1) Billing team must establish precertification workflow requiring all Lyfgenia (J3394) claims to be submitted to National Medical Excellence (NME) at 877-212-8811 before service delivery. (2) Update billing system to flag J3394 claims as requiring prior authorization and capture hematologist involvement. (3) Providers must document all eligibility criteria before billing: patient age (12+), confirmed SCD genotype, documented VOE history (≥2 per year for 2 years), HLA-matched donor status, prior hydroxyurea trial/contraindication, and absence of exclusionary conditions (HIV/HBV/HCV, malignancy, active infection, liver disease, bleeding disorder, immunodeficiency, cerebral vasculopathy, pulmonary hypertension, cardiac/pulmonary dysfunction, uncontrolled seizures, renal impairment). (4) Add mandatory notation on encounter forms that Lyfgenia must be administered ONLY at Aetna Institutes GCIT Network facilities—claims billed from non-network facilities will be denied. (5) Implement ICD-10 screening rules: D57.00-D57.09 and D57.1 are covered only when all criteria met; exclude claims with A00.0-B99.9, B16.0-B19.21, B20, B97.35, C00.0-C96.Z, D47.1-D47.4, D65-D69.9, D80.0-D84.9, G40.001-G40.C19, G46.8, I27.0, I27.20-I27.29, I50.0-I50.9, I67.2, I67.848, I67.89, J95.1-J95.3, K70.00-K77, K74.00-K74.02, N17.0-N19, R94.2, Z21, or Z85.00-Z85.9. (6) Train front-desk and billing staff: J3394 is one-lifetime-dose only per member; deny duplicate claims. Failure to obtain precertification or verify network facility will result in claim denials.