Using
d3d12_clear_memory_page_state: true
Seem to allow me to play Otomedius X without having to push F5 in the stage transitions as posted in the compatibility tracker, but there does appear to be a bit of slow down though which I'm ok with.
This also fixed the missing spinning ship in the character selection screen, which F5 also fixes.
One other side affect of this setting is after playing a game and going through the stage info screens they are a bit scrambled, which F5 fixes again.
Thanks for your awesome work on this emulator!