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Provider Quality

Provider-Quality


To ensure a continued focus on quality, Fidelis Care is dedicated to engaging with providers to ensure our members get the best care possible. Quality is a critical component of the work we do at Fidelis Care. The Provider Relations Department works diligently to support providers in quality improvement initiatives.


Hearthands

Quality Care Incentives (QCI) Program

Fidelis Care's QCI Program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. As your health plan partner, we remain committed to rewarding our providers for achieving high-quality outcomes and have made significant changes to the program for measurement year 2024 to align with our shared goals, encourage participation, and recognize regional differences within New York State.

Fidelis Care’s Quality Care Incentives (QCI) Program is available on Provider Access Online. Once logged in, please navigate to the File Downloads section to access the brochure.

Within the brochure, we are providing a summary of the components of our QCI Program, along with the associated coding specifications, to help you drive improvements in quality and to reward you for your efforts. Fidelis Care also provides monthly care gap reports to track your incremental performance, and identify those patients who may benefit from needed care and services.

If you have any questions regarding Fidelis Care’s Quality Care Incentives, please contact your Provider Partnership Associate.



Provider Access Online

Verify member eligibility or renewal status, check claims, send e-scripts, and more.

Provider Partnership Associates - Quality
NYC Region:

Name Coverage Area Assigned Counties and/or Providers
 OPEN
Brianni Blue Loftlin (Covering)

✉ Email Address

Zinaida Khavasova (Covering)    ✉ Email Address

Brooklyn County ZIP Codes: 11201, 11203, 11205, 11206, 11207, 11212, 11217, 11211, 11213, 11221, 11226, 11220, 11237, 11238, 11239, 11243, 11249 Brooklyn County
 Yen Min Yau

✉ Email Address

Brooklyn County ZIP Codes: 10013, 10002, 11220, 11219, 11204, 11214 Brooklyn County
 Zinaida Khavasova

✉ Email Address

Kings County ZIP Codes: 11204, 11209, 11210, 11214, 11218, 11219, 11223, 11224, 11228, 11229, 11230, 11232, 11234, 11235, 11236, 11239  Kings County
 Michael Gayle

✉ Email Address

Bronx County ZIP Codes: 10456, 10458, 10461, 10459, 10465, 10475, 10455, 10454, 10464, 10471, 10474, 10470, 10803, 10499, 10453, 10468, 10468, 10457, 10452, 10469, 10462, 10466, 10473 Bronx County


 Stanley Laforest

✉ Email Address

Manhattan County ZIP Codes: 10003, 10004, 10005, 10006, 10007, 10009, 10010, 10011, 10012, 10014, 10016, 10017, 10018, 10019, 10020, 10021, 10022, 10023, 10024, 10025, 10026, 10027, 10029, 10030, 10031, 10032, 10033, 10034, 10035, 10036, 10038, 10039, 10040, 10041, 10044, 10047, 10048, 10128 Manhattan County
OPEN
Taylor Panzarella (Covering)

✉ Email Address

Osaruyi Eduwen (Covering)

✉ Email Address

Rosemond Guillaume (Covering)

✉ Email Address

Brooklyn County ZIP Codes: 11238, 11212, 11236, 11234
Providers: NYU, Mt.Sinai, NY Presby, NYNM
 Osaruyi Eduwen

✉ Email Address

Queens County ZIP Codes: 11101, 11102, 11103, 11104, 11105, 11106, 11368, 11369, 11370, 11371, 11372, 11373,1 1374, 11375, 11377, 11378, 11379, 11385 Queens County
 Kellimar James-Nixon

✉ Email Address

Queens County ZIP Codes: 11004, 11354, 11355, 11356, 11357, 11358, 11360, 11361, 11362, 11363, 11364
Queens County
 Rosemond Guillaume

✉ Email Address

Queens County ZIP Codes: 11365, 11366, 11367, 11411, 11412, 11413, 11414,
11415, 11421, 11422, 11430, 11433, 11434, 11435; 11416, 11417, 11419, 11420,
11423, 11426, 11427, 11428, 11429, 11432, 11418, 11436, 11691, 11692, 11693,
11694, 11697
Queens County

 OPEN
Rosemond Guillaume (Covering) ✉ Email Address

Haneefah Mahdi (Covering)
✉ Email Address


Rockland and Westchester County ZIP Codes: 10977, 10952, 10956, 10901, 10954, 10965, 10980, 10970, 10960, 10989, 10927, 10994, 10923, 10920, 10962, 10983, 10913, 10993, 10974, 10984, 10986, 10968, 10964, 10976, 10931, 10911, 10982, 10701, 10801, 10573, 10705, 10583, 10550, 10704, 10562, 10598, 10710, 10558, 10566, 10557, 10708, 10552, 10703, 10567, 10605, 10543, 10591, 10603, 10805, 10549, 10580, 10804, 10538, 10606, 10528, 10514, 10530, 10803, 10604, 10553, 10570, 10536, 10601, 10520, 10707, 10522, 10523, 10595, 10510, 10709 Rockland and Westchester County

 Haneefah Mahdi

✉ Email Address

Richmond County ZIP Codes: 10301, 10302, 10303, 10304, 10305, 10304, 
10305, 10306, 10307, 10308, 10309, 10310, 10311, 10312, 10313, 10314
Richmond County
 Leidy Mejia

✉ Email Address

Nassau County ZIP Codes: 11096, 11509, 11510, 11516, 11518, 11520, 11550, 11552, 11553, 11554, 11555, 11557, 11558, 11559, 11563, 11565, 11566, 11570, 11572, 11575, 11580, 11581, 11598, 11709, 11710, 11756, 11758, 11762, 11783, 11793,11001, 11020, 11021, 11023, 11024, 11030, 11040, 11042, 11050, 11501, 11507, 11514, 11530, 11542, 11545, 11548, 11560, 11568, 11576, 11577, 11579, 11590, 11596, 11714, 11732, 11735, 11753, 11771, 11791, 11797, 11801 Nassau County
 Susan Jacob

✉ Email Address

Suffolk County ZIP Codes: 11702, 11706, 11705, 11716, 11717, 11719, 11933, 11934, 11720, 11721, 11722, 11724, 11725, 11727, 11729, 11730, 11731, 11772, 11941, 11738, 11946, 11788, 11743, 11746, 11749, 11751, 11752, 11754, 11755, 11948, 11757, 11949, 11950, 11951, 11763, 11747, 11954, 11766, 11767, 11701, 11703, 11713, 11777, 11961, 11901, 11778, 11779, 11962, 11782, 11784, 11733, 11787, 11780, 11790, 11704, 11795, 11796, 11977, 11978, 11798, 11980  Suffolk County


Upstate Regions:

Name Coverage Area
Assigned Counties and/or Providers
 Jane Sanderson

✉ Email Address

Rensselaer County ZIP Codes: 12180, 12144, 12182, 12061, 12033, 12198, 12090, 12179, 12018, 12123, 12196, 12154, 12138, 12121, 12094, 12185, 12168, 12062, 12052, 12156, 12140, 12153, 12028 ,12057, 12022 12169, 12063, 12082, 12181, 12089, 12133, 12040                                                                                   

Saratoga County ZIP Codes
: 12065, 12866, 12020, 12010,  12831, 12118, 12019, 12188, 12828, 12803, 12148, 12822, 12170, 12871, 12025, 12833, 12134, 12027, 12850, 12074, 12859, 12835, 12151, 12863, 12086,  12884 

Schenectady County ZIP Codes:  12008, 12053, 12056, 12137 , 12141, 12150, 12301, 12302, 12303 ,12304, 12305 , 12306 ,12307, 12308, 12309, 12325, 12345 

Washington County ZIP Codes:  12839, 12828, 12834, 12832, 12887, 12827, 12816, 12865, 12809, 12154, 12094, 12821, 12185, 12028, 12057, 12837, 12873, 12861, 12819, 12823, 12838, 12849, 12841, 12844, 12848, 12854     
Counties: Rensselaer, Saratoga, Schenectady, Washington
 Barbara Bentley-Morrill

✉ Email Address

Albany County ZIP Codes: 12309, 12203, 12205, 12303, 12047, 12208, 12304, 12110, 12189, 12054, 12206, 12211, 12210, 12209, 12009, 12202, 12159, 12204, 12077, 12158, 12186, 12143, 12084, 12053, 12083, 12111, 12183, 12262, 12222, 12023, 12067, 12207, 12193, 12059, 12087, 12469, 12046, 12120, 12147, 12226, 12460, 12041, 12234, 12085, 12007, 12201, 12212, 12214, 12220, 12223, 12224, 12225, 12227, 12228, 12229, 12230, 12231, 12232, 12233, 12235, 12236, 12237, 12238, 12239, 12240, 12241, 12242, 12243, 12244, 12245, 12246, 12247, 12248, 12249, 12250, 12255, 12257, 12260, 12261, 12288, 12107, 12128, 12161, 12045, 12055

Clinton County ZIP Codes:  12901, 12972, 12962, 12918, 12992, 12919, 12944,  12981, 12910, 12958, 12921, 12935, 12912, 12903, 12979, 12929 ,12959, 12985, 12934, 12923, 12955, 12952, 12911, 12924, 12978, 12933 

Columbia County ZIP Codes: 12534, 12571, 12184, 12526, 12037, 12075, 12546, 12106, 12529, 12583, 12567, 12060, 12173, 12516, 12521, 12523, 12156, 12125, 12029, 12502, 12136, 12565, 12503, 12017, 12130, 12513, 12517, 12115, 12024, 12165, 12132, 12593, 12174, 12530, 12195, 12172, 12050, 12541, 12544

Essex County ZIP Codes: 12983, 12946, 12883, 12944, 12928, 12912, 12870, 12941, 12960, 12974, 12996, 12932, 12997, 12993, 12943, 12950, 12851, 12936, 12987, 12913, 12956, 12857, 12852, 12942, 12998, 12964, 12961, 12855, 12858, 12975, 12977, 12872, 12879 

Greene County ZIP Codes: 12414, 12051, 12143, 12083, 12015, 12413, 12192, 12496, 12058, 12463, 12431, 12468, 12451, 12087, 12430, 12423, 12473, 12427, 12436, 12442, 12405, 12480, 12418, 12470, 12424, 12450, 12444, 12485, 12492, 12482, 12422, 12454, 12407, 12460, 12042, 12176, 12439, 12490, 12452, 12124   

Warren County ZIP Codes: 12804, 12801, 12845, 12885, 12846, 12817, 12853, 12814, 12856, 12843, 12815, 12824, 12878, 12808, 12836, 12810, 12860, 12874, 12844, 12862, 12886, 12811, 12820  
Counties: Albany, Clinton, Essex, 
Columbia, Greene, Warren
 Jaime Laube

✉ Email Address

Orange County ZIP Codes: 10950, 12550, 10940, 12553, 10990, 12589, 10941, 10924, 12771, 10918, 12566, 12549, 10980, 12586, 10930, 10992, 10928, 12721, 12518, 10963, 10916, 10998, 10921, 10987, 10925, 12575, 10958, 10926, 12577, 12780, 12520, 10973, 10986, 12729, 12746, 12543, 10969, 10996, 10917, 10919, 10975, 10914, 10922, 10933, 12785, 10911, 10943, 10985, 10910, 10912, 10915, 10932, 10949, 10953, 10959, 10979, 10981, 10988, 10997, 12551, 12552, 12555, 12584  

Putnam County ZIP Codes: 10541, 10512, 10509, 12563, 10579, 10516, 10524, 12531, 10588, 10537, 10542

Sullivan County ZIP Codes: 12701, 12721, 12754, 12790, 12758, 12788, 12747, 12776, 12783, 12775, 12764, 12723, 12789, 12729, 12768, 12740, 12748, 12737, 12779, 12763, 12734, 12726, 12719, 12733, 12759, 12732, 12777, 12765, 12751, 12760, 12762, 12786, 12725, 12766, 12742, 12743, 12770, 12785, 12778, 12741, 12720, 12745, 12738, 12750, 12724, 12749, 12736, 12769, 12787, 12791, 12792, 12752, 12767, 12781, 12784, 12722, 12727  

Ulster County ZIP Codes:  12401, 12477, 12561, 12589, 12528, 12566, 12428, 12446, 12542, 12758, 12443, 12487, 12498, 12404, 12525, 12547, 12449, 12484, 12466, 12458, 12548, 12455, 12440, 12491, 12461, 12740, 12486, 12515, 12409, 12494, 12472, 12464, 12406, 12481, 12410, 12480, 12456, 12457, 12433, 12725, 12411, 12419, 12435, 12495, 12416, 12412, 12448, 12475, 12429, 12465, 12493, 12490, 12471, 12441, 12489, 12483, 12782, 12402, 12417, 12420, 12432, 12453, 12568, 12588  
Counties: Orange, Putnam,
Sullivan, Ulster
 Penny Patterelli

✉ Email Address

Oneida County ZIP Codes: 13440, 13501, 13502, 13413, 13421, 13323, 13492, 13403, 13316, 13309, 13308, 13354, 13476, 13478, 13480, 13456, 13438, 13495, 13471, 13461, 13042, 13424, 13417, 13363, 13318, 13425, 13490, 13431, 13054, 13304, 13477, 13338, 13328, 13303, 13322, 13321, 13486, 13441, 13469, 13319, 13494, 13440, 13501, 13502, 13413, 13421, 13323, 13492, 13403, 13316, 13309, 13308, 13354, 13476, 13478, 13480, 13456, 13438, 13495, 13471, 13461, 13042, 13424, 13417, 13363, 13318, 13425, 13490, 13431, 13054, 13304, 13477, 13338, 13328, 13303, 13322, 13321, 13486, 13441, 13469, 13319, 13494, 13483, 13157, 13455, 13352, 13162, 13301, 13435, 13341, 13362, 13401, 13313, 13123, 13442, 13449, 13479, 13503, 13504, 13505, 13599  

Otsego County ZIP Codes:  13820, 13326, 13849, 13439, 13491, 13411, 13825, 12197, 13843, 13320, 12155, 13809, 13807, 13810, 13335, 13315, 13808, 13750, 12116, 13485, 13348, 13796, 13361, 13337, 13468, 13861, 12064, 13776, 13450, 12036, 13342, 13333, 13415, 13488, 13859, 13860, 13457, 13482, 13747, 13834   

Schoharie County ZIP Codes: 12043, 12053, 12122, 12157, 12149, 12023, 13459, 12066, 12093, 12167, 12092, 12076, 12469, 12160, 12187, 12175, 12035, 12064, 12031, 12036, 12194, 12071, 12131, 12073

Counties: Oneida, Otsego,
Schoharie
 Jeannie Vanhoeven

✉ Email Address

Fulton County ZIP Codes: 12010, 12078, 12095, 12025, 13452, 13329, 12117, 12070, 12032, 12086, 13470 

Franklin County ZIP Codes: 12953, 12983, 12986, 12966, 13655, 12920, 12926, 12916, 12957, 12937, 12917, 12980, 12989, 12914, 12970, 12945, 12930, 12976, 12913, 12955, 12969, 12995, 12915, 12939, 13683   

Hamilton County ZIP Codes: 12134, 13324, 12842, 13454, 12856, 12032, 12108, 12847, 12190, 13360, 12139, 13436, 12812, 12164, 13353, 12864

Montgomery County ZIP Codes: 12010, 13339, 13452, 13317, 12068, 12072, 12070, 12066, 12166, 12137, 13428, 12086, 12177, 13410, 12069, 12016  

Saint Lawrence County ZIP Codes: 13662, 13676, 13669, 13617, 13642, 12986, 13667, 13668, 13658, 13646, 13613, 13654, 13697, 13625, 13648, 13679, 13660, 13652, 13630, 13684, 13694, 13680, 13681, 12980, 13621, 12967, 13635, 12914, 13690, 13687, 13672, 13670, 13633, 12927, 12965, 13614, 13666, 13695, 13664, 12922, 13639, 12973, 13649, 12949, 13623, 13645, 13647, 13677, 13678, 13696, 13699 
Counties: Fulton, Franklin, Hamilton,
Montgomery, Saint Lawrence
 Sarah Freyer

✉ Email Address

Dutchess County ZIP Codes: 12603, 12601, 12590, 12533, 12508, 12524, 12538, 12569, 12571, 12572, 12540, 12564, 12570, 12582, 12522, 12545, 12580, 12531, 12594, 12546, 12581, 12514, 12501, 12583, 12578, 12567, 12592, 12585, 12507, 12604, 12574, 12602, 12504, 12506, 12510, 12511, 12512, 12527, 12537
Dutchess County
 Maureen Hudson

✉ Email Address

Erie County ZIP Codes: 14004, 14026, 14031, 14043, 14051, 14059, 14086, 14094, 14202, 14203, 14206, 14209, 14212, 14214, 14215, 14216, 14217, 14220, 14225, 14226 Erie County

Providers: Kaleida, General Physicians 

VBP IPAs:  CINQ, CIPA, and GLIN
 Christine Pinelli

✉ Email Address

Allegany County ZIP Codes: 14895, 14727, 14813, 14739, 14880, 14807, 14806, 14735, 14715, 14804, 14770, 14803, 14065, 14744, 14717, 14709, 14711, 14846, 14836, 14060, 14822, 14536, 14897, 14754, 14777, 14714, 14708, 14884, 14802, 14721, 14707, 14774, 14029, 14745, 14786

Cattaraugus County ZIP Codes
: 14760, 14141, 14779, 14070, 14009, 14706, 14727, 14737, 14042, 14719, 14738, 14772, 14755, 14741, 14770, 14138, 14747, 14171, 14101, 14726, 14743, 14129, 14065, 14731, 14060, 14753, 14729, 14748, 14783, 14173, 14041, 14788,14133, 14168, 14730, 14751, 14766, 14778    

Chautauqua County ZIP Codes: 14701, 14048, 14063, 14136, 14750, 14787, 14733, 14062, 14710, 14738, 14081, 14712, 14757, 14775, 14724, 14781, 14767, 14716, 14138, 14782, 14747, 14726, 14718, 14723, 14728, 14784, 14769, 14740, 14720, 14722, 14736, 14135, 14166, 14742, 14785, 14702, 14732, 14752, 14756, 14758 

Erie County ZIP Codes
: 14006, 14043, 14047, 14052, 14057, 14075, 14111, 14127, 14141, 14218, 14224 

Wyoming County ZIP Codes: 14004, 14011, 14569, 14530, 14009, 14525, 14550, 14040, 14427, 14024, 14591, 14167, 14145, 14066, 14037, 14536, 14113, 14082 14039, 14549, 14083, 14130        
Counties: Allegany, Cattaraugus,
Chautauqua, Erie, Wyoming
 Christine Jendraszek

✉ Email Address

Erie County ZIP Codes:  14001, 14032, 14150, 14201, 14208, 14219, 14221, 14223, 14227 and 14228

Genesee County ZIP Codes: 14020, 14482, 14036, 14125, 14416, 14422, 14525, 14005, 14058, 14040, 14591, 14013, 14054, 14143, 14056, 14021 and 14557  

Livingston County ZIP Codes: 14454, 14437, 14472, 14414, 14510, 14487, 14572, 14423, 14485, 14435, 14517, 14533, 14560, 14466, 14481, 14846, 14836, 14822, 14462, 14480, 14486, 14556, 14545, 14592, 14488, 14539 and 14558           

Steuben County ZIP Codes: 14830, 14843, 14810, 14437, 14870, 14801, 14572, 14871, 14823, 14840, 14821, 14812, 14807, 14806, 14873, 14826, 14809, 14879, 14898, 14858, 14820, 14839, 14819, 14855, 14885, 14815, 14877, 14874, 14808, 14893, 14827, 14831, 14529 and 14856                                                                                                                              Wyoming County ZIP Codes:  14004, 14011, 14569, 14530, 14009, 14525, 14550, 14040, 14427, 14024, 14591, 14167, 14145, 14066, 14037, 14536, 14113, 14082 14039, 14549, 14083 and 14130        

Counties: Erie, Genesee, Livingston,
Steuben, Wyoming
 Nicole Helsdon

✉ Email Address

Monroe County ZIP Codes: 14580, 14450, 14609, 14624, 14612, 14534, 14621, 14626, 14606, 14618, 14623, 14616, 14620, 14617, 14468, 14526, 14420, 14615, 14559, 14607, 14611, 14613, 14619, 14610, 14622, 14608, 14586, 14605, 14467, 14625, 14428, 14472, 14664, 14445, 14464, 14546, 14673, 14514, 14543, 14604, 14627, 14614, 14683, 14506, 14511, 14645, 14508, 14515, 14410, 14430, 14694, 14602, 14603,14638, 14639, 14642, 14643, 14644, 14646, 14647, 14649, 14650, 14651, 14652, 14653, 14692

Niagara County ZIP Codes:  14094, 14120, 14304, 14305, 14301, 14092, 14303, 14132, 14174, 14105, 14131, 14108, 14067, 14172, 14012, 14008, 14028, 14126, 14095, 14107, 14109, 14144, 14302, 14222 

Orleans County ZIP Codes: 14411, 14103, 14470, 14105, 14098, 14476, 14058, 14477, 14571, 14479, 14429, 14452   
Counties: Monroe, Orleans, Niagara

Providers - Erie County: Jericho
 Road Ministries, Genesee Transit Pediatrics,
and Paul DeJac                                                                                         
VBP IPAs: SNAPCAP
 Robert Chantra

✉ Email Address

Ontario County ZIP Codes: 14424, 14456, 14564, 14425, 14522, 14469, 14432, 14487, 14548, 14512, 14532, 14485, 14561, 14471, 14560, 14544, 14466, 14504, 14475, 14537, 14585, 14461, 14463, 14518, 14443, 14453, 14547
Ontario County

Providers: GRIPA (all counties) & Guthrie
and University of Rochester     

VBP IPAs:  FLIPA, GRIPA, Guthrie 
 Andre Burton

✉ Email Address

Seneca County ZIP Codes:  14850, 14456, 13165, 13148, 14886, 14532, 14521, 13146, 14847, 14541, 14860, 14841, 13065, 14588

Schuyler County ZIP Codes: 14886, 14837, 14891, 14812, 14865, 14818, 14864, 14869, 14878, 14824, 14805, 14841, 14815, 14876, 14887, 14863

Wayne County ZIP Codes:  14513, 14519, 14502, 14522, 14489, 14589, 14568, 14551, 14505, 14433, 14590, 13143, 13146, 14516, 14555, 13154, 14520, 14538, 14542, 14413, 14449, 14563 
Counties:  Seneca, Schuyler, Wayne

Providers: Arnot                                                                   

VBP IPAs:  NCI   
 Karen Yonkers-Santy

✉ Email Address

Cortland County ZIP Codes: 13045, 13077, 13159, 13803, 13053, 13040, 13101, 13835, 13052, 13158, 13141, 13863, 13841, 13087, 13738, 13056, 13784

Oswego County ZIP Codes: 13126, 13069, 13036, 13114, 13142, 13135, 13074, 13167, 13132, 13131, 13044, 13042, 13493, 13076, 13111, 13083, 13661, 13302, 13145, 13144, 13028, 13437, 13103, 13426, 13093, 13107, 13115, 13121                                

Tioga County ZIP Codes:
  13760, 13827, 14892, 13732, 13811, 14883, 13743, 13812, 13736, 13734, 13835, 13864, 14859, 13840, 13845            

Tompkins County ZIP Codes: 14850, 13068, 14886, 13073, 14867, 13053, 14883, 14882, 13736, 14817, 13864, 14853, 14881, 14852, 13062, 13102, 14851, 14854
Counties: Cortland, Oswego, Tioga,
Tompkins
 Peter Stone

✉ Email Address

Onondaga County ZIP Codes: 13027, 13090, 13210, 13208, 13212, 13088, 13204, 13039, 13203, 13205, 13206, 13031, 13104, 13057, 13219, 13215, 13207, 13041, 13066, 13209, 13078, 13260, 13224, 13152, 13214, 13029, 13202, 13077, 13108, 13211, 13135, 13159, 13084, 13082, 13080, 13120, 13030, 13116, 13110, 13164, 13060, 13063, 13112, 13141, 13122, 13020, 13153, 13201, 13217, 13218, 13220, 13221, 13225, 13235, 13244, 13250, 13251, 13252, 13261, 13290, 13051, 13089, 13119, 13137, 13138 Onondaga County                                                                                         
APP Groups (Wellcare ONLY): 
Family Care Medical Group                                               

VBP Group:  Summerwood Peds


Provider Office Hours

Fidelis Care hosts webinars called “Provider Office Hours” several times each month to share information and answer any of your questions. 

Provider Satisfaction Survey

Your provision of quality care and services to our members contributes greatly to Fidelis Care’s success. One of the ways Fidelis Care prioritizes quality is making sure you are satisfied with your experiences. Our annual Provider Satisfaction Survey identifies areas to focus on for further improvement in the coming year. The Provider Relations Department works diligently to identify an action plan to address areas of improvement, while continuing to develop actions and interventions to improve the provider experience.

Resources

Fidelis Care offers resources including Provider Bulletins, tip sheets, educational materialsblog posts, and more to keep you informed.


 

WINTER 2025 PROVIDER BULLETIN


  • Social Care Networks Program (SCN) Now Live
  • Fidelis Care Provider Portal and Availity Essentials Transition
  • Encourage Patients to Get Screened for Hepatitis C
  • Family Planning and Reproductive Healthcare
  • The Importance of Domestic Violence Screening

 

 

Provider Quality News


What Is Gestational Diabetes?
11/18/2022 • Posted by Fidelis Care in Diabetes, Health and Wellness, Women's Health

Pregnant woman visiting doctorGestational diabetes is a type of diabetes that occurs during pregnancy. An expectant mother’s blood sugar levels become too high, which can cause health risks for the mother and baby.

Doctors don’t know the cause of gestational diabetes, but it may be related to hormones that are produced during pregnancy. Sometimes, these hormones block insulin to the mother’s body, causing “insulin resistance.” Insulin resistance makes it hard for the mother’s body to use insulin. Insulin helps to control blood sugar levels.

Who is affected by gestational diabetes?

Gestational diabetes can occur in pregnant women who have never had diabetes and whose high blood sugar levels are first detected during pregnancy. It is not the same as being diagnosed with type 1 or type 2 diabetes before becoming pregnant. Each year, up to 10% of pregnant women in the U.S. develop gestational diabetes, according to the Centers for Disease Control and Prevention. 

When is gestational diabetes diagnosed?

Healthcare providers usually test pregnant women for gestational diabetes between 24 and 28 weeks of pregnancy. 

How do you test for gestational diabetes?

There are two different ways to test for gestational diabetes.

  • Two-part test: This is the most common method used in the U.S. The mother’s blood sugar is measured one hour after consuming a sugary drink. If her blood sugar level is higher than 200mg/dl, an oral glucose tolerance test will be given. For the oral glucose tolerance test, the mother will fast (no eating) overnight. Blood sugar levels are then measured while fasting, and then one, two, and three hours after consuming the sugary drink.
  • One-part test: Fasting blood glucose (sugar) levels are measured, and then again one hour and two hours after the mother consumes a sugary drink.

Who is at risk of developing gestational diabetes?

Risk factors for developing gestational diabetes include:

  • Obesity or excess weight
  • Not getting enough exercise
  • A history of gestational diabetes in a previous pregnancy, or a family history of type 2 diabetes or prediabetes
  • Previously giving birth to a baby 9 pounds or heavier
  • High blood pressure, polycystic ovary syndrome (PCOS), or a history of heart disease
  • Women of the following ethnicities: African American, Asian American, Hispanic, Native American, or Pacific Island
  • Women older than 25

How do you treat gestational diabetes?

It is important to act quickly to treat gestational diabetes. Eating healthy foods in the right amounts and regular exercise can help. Healthcare providers will discuss the level of exercise that is safe. Treatment can also include daily blood glucose testing and insulin injections.

How does gestational diabetes affect pregnancy?

If left untreated, gestational diabetes can lead to health concerns during pregnancy, such as:

  • Giving birth to a large baby (weighing more than 9 pounds), increasing the risk of injury during birth for both the baby and the mother.
  • Increased risk of miscarriage, birth defects, and stillbirths.
  • High blood pressure, which can affect both long-term and short-term health.
  • Preeclampsia, a serious complication where the expectant mother has high blood pressure with possible kidney or liver damage.

What effects does gestational diabetes have after pregnancy?

  • If blood glucose levels remain high after giving birth, it’s likely that the mother has type 1 or type 2 diabetes.
  • Women who get gestational diabetes have an increased chance of later developing type 2 diabetes. Eating healthy and getting exercise lessens the risk.

Talk to a healthcare professional about appropriate screening and follow-up.

Visit fideliscare.org/diabetes to learn more about diabetes.

External Resources:

https://diatribe.org/gestational-diabetes

https://diabetes.org/diabetes/gestational-diabetes