Get Hin Distribution File Layout - Hibcc - Hibcc

This guide provides a step-by-step approach to completing the HIN distribution file layout - HIBCC online. Following these instructions will ensure that users can successfully navigate the form and submit accurate information.

Follow the steps to complete the HIN distribution file layout.

1. Press the 'Get Form' button to access the form and open it in the editor.
2. Begin by filling in the 'Record Type' field, indicating whether it is a facility record (BE) or a location record (LO).
3. Enter the 'Base HIN', which consists of the first seven digits of the Health Industry Number.
4. For the 'Suffix' field, input 'ØØ' for facility records or use sequentially ascending suffixes starting from 'FØ' for prescriber or location records.
5. Provide the legal or DBA 'Name' of the facility, prescriber, or location in the respective field.
6. Fill out the first line of the address in the 'Address1' field and any additional address information in 'Address2'.
7. Specify the 'City', 'State', and 'ZIP' code, ensuring all data is accurate.
8. Enter the corresponding 'Country' using the ISO 3166 country code.
9. Input the 'Telephone' number for the facility, including the area code, ensuring it is left-justified and without delimiters.
10. Choose the appropriate 'Class of Trade' code based on the facility type or location activity.
11. If applicable, enter the 'DEA' number in the designated field.
12. Provide the 'Date HIN Assigned' in the format yyyymmdd and ensure the last edit date is recorded correctly in 'Date Last Edited'.
13. Select the 'Status', indicating whether it is active (AC) or deactivated (DE).
14. Indicate if the record is 'Verified' using the options VF for verified or NV for not verified.
15. Include the 'Last Action Code' to illustrate the most recent update performed on the record.
16. Complete the 'Reason Code' field with the corresponding reason for adding, changing, or deactivating the record.
17. If needed, input a 'Referback Code' for any references to other records.
18. Specify the 'Subset' if applicable, such as HH for Human Health Facilities or CE for U.S. Public Health Service Covered Entities.
19. For prescribers, include the 'UPIN' and 'Specialty' codes as necessary.
20. Provide a fax number in the 'Fax' field if required for prescribers.
21. Once all fields are completed, users can save their changes, download, print, or share the form as needed.

Start filling out your HIN distribution file layout online today for a seamless submission process.