For other uses, see Dominic (disambiguation). Dominic is a name common among Roman Catholics and other Latin-Romans as a boys name. Originally from the late Roman-Italic name Dominicus its translation means Of Our Lord, Lordly, Belonging to God or of the Master.
ï· Call us at 1-888-693-3211. ï· Fax an eviCore healthcare request form (available online) to 1-888-693-3210. Also, to ease the administrative burden of requiring prior authorization of OB Ultrasound studies, providers may batch service requests for up to 12 weeks and cases may be reviewed retrospectively for.
PRIOR AUTHORIZATION REQUEST FORM. EOC ID: EnvisionRx Genotropin Prior Authr. rPhone: 800-361-4542rFax back to: 866-414-3453 r. ENVISION RX OPTIONS manages the pharmacy drug benefit for your patient. Certain requests for coverage require review with the prescribing. physician. Please answer the following questions and fax this form to the number listed above.